Journal of Contemporary Brachytherapy
eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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5/2025
vol. 17
 
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abstract:
Original paper

Personalized brachytherapy in gynecological cancers: procedural narrative in patients with a poor response or challenging anatomy after chemoradiation

Supriya Chopra
1
,
Sam David
2
,
Anuradha Krishnan
2
,
Nisarga Vontikoppal Manjunath
2
,
Prachi Mittal
2
,
Ankita Gupta
1
,
Prachi Sawant
2
,
Jeevanshu Jain
1
,
Yogesh Ghadi
3

  1. Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, Maharashtra, India
  2. Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
  3. Department of Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
J Contemp Brachytherapy 2025; 17, 5: 282–292
DOI: https://doi.org/10.5114/jcb.2025.155997
Online publish date: 2025/10/31
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Purpose
Brachytherapy plays a critical role in managing gynecological cancers. However, for patients who have a poor response to chemoradiation or present with complex anatomy, delivering tumoricidal doses may be challenging. In this case series, we present a descriptive narrative of techniques adopted for brachytherapy, dosimetric and early clinical outcomes for such clinical challenging cases.

Material and methods
Patients who had a poor response to chemoradiation or with challenging anatomy received individualized brachytherapy between 2021 and 2023. All underwent pre-brachytherapy clinical assessment and MRI. These patients were treated with personalized brachytherapy techniques based on tumor extent and anatomy. Manual dose optimization and adjustments to dose fractionation were tailored on a case-by-case basis maximizing tumor control and limiting organ-at-risk doses.

Results
In the six patients included in this report, the median high-risk clinical target volume (HR-CTV) volume was 51.1 cc. For each patient, the implant was individualized using a combination of applicators, 3D-printed applicators or freehand needles. At a median follow-up of 31 months, three out of six patients were locally controlled. Out of the three patients with locally controlled disease, one patient developed grade 2 posterior fourchette necrosis.

Conclusions
Though the results provide a descriptive narrative, they also highlight a clinical care gap that brachytherapy alone cannot yet address for patients. Advancing individualized brachytherapy by incorporating novel agents and techniques may help improve treatment outcomes.

keywords:

brachytherapy, poor responders, gynecological malignancies, challenging anatomy, personalized brachytherapy

  
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