gynecologic cancer intergroup cervix cancer research network de becker elekta.pdf · elekta...
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Elekta Brachytherapy in Latin America
Jan De Becker
Elekta Brachytherapy
Cervix Cancer Education Symposium, January 2017, Mexico
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Cervical Cancer Incidence
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Cervical Cancer Incidence
From: BRAY, Freddie and PINEROS, Marion. Cancer patterns, trends and
projections in Latin America and the Caribbean: a global context. Salud pública
Méx [online]. 2016, vol.58, n.2 [cited 2017-01-17], pp.104-117.
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Cervical Cancer Mortality
From: Negrin, Epidemiology of cervical cancer in Latin America.
Ecancermedicalscience, 2015;9:577.
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
HPV Vaccination
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Brachytherapy in LatAm
From: Guedea et al Brachytherapy 10 (2011) 363-368
Distribution of cases by localization
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Trends in GYN Brachytherapy
• Treatment Regimen and Competing Modalities– The Need of Brachytherapy
• 3D Image Guided Adaptive Brachytherapy– Supported by Clinical Outcome
– Guidelines and recommendations
• Interstitial Brachytherapy– Growing Need
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Brachytherapy
Essential part in treatment of cervical cancer
In a recent study, cervical cancer patients that received brachytherapy as boost after
external beam radiation therapy had a 12% better overall survival rate at four
years than patients who didn’t receive the brachytherapy
boost.1
[1] Han K et al. Int J Radiation Oncol Biol Phys 2013;87:111-119
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
3D IGABT• 3D Imaging (CT or MRI) with the applicator inserted
• Applicator Reconstruction on 3D Data
• Contouring• HR- CTV: High Risk Clinical Target Volume
• IR-CT: Intermediate Risk Clinical Target Volume
• OAR: Organs At Risk• Bladder
• Rectum
• Sigmoid
• Dose plan adapted to the patients’ case
Lindegaard J et al. Acta Oncologica 2013;52:1510-1519
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
3D IGABT Improves Clinical Outcome
RetroEMBRACE Multi-center Study
IGBT improves pelvic control by approximately 10% compared to conventional 2D BT. [1]
IGBT improves overall survival compared to historical data [1] [8] [9]
[1] Sturdza et al, Radiother Oncol. 2016
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
3D IGABT Improves Clinical OutcomeRetroEMBRACE
FIGO stage
Total
number of
patients
Overall
Survival at 5
years
Cancer
Specific
Survival at 5
years
IB 123 83% 90%
IIA 42 80% 84%
IIB 368 70% 77%
IIIA 23 42% 48%
IIIB 145 42% 53%
IVA 23 32% 40%
Total 731 65% 73%
FIGO Stage
5-Year
Observed
Survival Rate
0 93%
IA 93%
IB 80%
IIA 63%
IIB 58%
IIIA 35%
IIIB 32%
IVA 16%
IVB 15%
Based on data
collected by the
USA National
Cancer Data Base
from people
diagnosed
between 2000 and
2002
[1] Sturdza et al, Radiother Oncol. 2016
The above mentioned figures are not fully comparable.
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
3D IGABT with interstitial needles improves Local Control
[1] Fokdal et al, Radiother Oncol. 2016
Combined IC/IS brachytherapy improves local control by enabling a tumour specific dose escalation
resulting in significantly higher local control in large tumours without adding treatment related late
morbidity. [1]
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
What is Elekta doing today to improve
treatment, accessibility and adoption?
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Engagement with the key stakeholders in the treatment of Cervical Cancer
Clinical Trial support
Education
Product/Procedure support and customer training
Innovation
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Support of EMBRACE 1 and EMBRACE 2 studies
First Results published in special issue Green Journal:
Radiotherapy and Oncology 120 (2016)
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Support of GCIG and CCRN
• Gynecologic Cancer Intergroup (GCIG)– Global studies in endometrial and cervical
cancer
• More focused collaboration with Cervix
Cancer Research Network (CCRN)– Leading up to meeting today
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Journal of Contemporary Brachytherapy:
Educational Activity
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
BrachyAcademy: Tailored peer-to-peer education platform
www.brachyacademy.com
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
BrachyTalk and Educational Procedure videos
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Gynecology Workshops
Cervix brachytherapy workshops also held in Austria, United States, India, Hong Kong and China
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Cervix Brachy Education Centers/Reference sites
National University Hospital, Singapore
Chiang Mai University Hospital , Thailand
King Chulalongkorn Memorial Hospital, Thailand
TATA Memorial Hospital, India
Gunma University Hospital, Japan
Dr. Negrin University Hospital, Spain
Hospital Charles-Le Moyne, Canada
Leiden University Medical Centre, Netherlands
Medical University of Vienna, Austria
National Centre for Cancer Care and Research, Qatar
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Elekta solutions for image-guided adaptive brachytherapy
Largest CT/MR compatible
applicator portfolio
Now also a new option for
advanced staged cervical
cancer: Venezia*™
Intelligent tools to simplify treatment
planning – eg. speed up reconstruction
and optimize dosimetry
State of the art treatment delivery:
Intuitive, safe, accurate
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Elekta InnovationOne-click system
for easy assembly
Advanced Gynecological ApplicatorVeneziaTM
Cervical stopper
integrated
The ovoid holes allow parallel
and oblique needles to reach
the parametrium
2 lunar-shaped
ovoids that
when clicked
together form a ring
Cylinder caps allow treatment
of the vaginal wall
Perineal
templates for
reaching
vaginal
extensions
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Benefit from full support, education and training
• On-site
implementation
team to support clinical
start and initial
procedures
• Network of experienced
BT specialists and
service professionals
available 24/7
• Peer-to-peer education
through
BrachyAcademy.com
• Training onsite
• In-depth training
for the whole team
at Elekta Learning and
Innovation Center (LINC)
in Atlanta, Beijing
• Innovator &
market leader in
BT since 1975
• Used in over
2000 hospitals
worldwide
Implementation Support Training & ServicesElekta Brachytherapy
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Gynecologic Cancer InterGroup
Cervix Cancer Research Network
Cervix Cancer Education Symposium, January 2017, Mexico
Thank you for your attention