Author: Daniela Branco, John M Bryant, Surendra Bahadur Chand, Pratiksha Shahi, Joseph Weygand 👨🔬
Affiliation: Department of Radiation Oncology and Applied Science, Dartmouth Health, B.P. Koirala Memorial Cancer Hospital, , B.P Koirala Memorial Cancer Hospital, University of California San Diego / California Protons, Department of Radiation Oncology, Moffitt Cancer Center 🌍
Purpose:
Cervical cancer remains a significant health burden in Nepal, with 2169 new cases and 1313 deaths recorded in 2022. This study evaluates the feasibility of implementing step-and-shoot IMRT for cervical cancer treatment in a resource-limited setting, comparing its dosimetric outcomes and practical implementation challenges with the currently used 3D-CRT technique.
Methods: Retrospective IMRT plans were created for ten stage II cervical cancer patients treated at a major cancer center in Nepal, prescribed 50 Gy in 25 fractions, and compared to clinically implemented 3D-CRT plans to assess dosimetric differences. Mean doses to organs at risk (bladder and rectum) were evaluated, and statistical analysis was performed using the Wilcoxon Signed Rank Test, with a significance level set at 0.05. The time required to create each plan was recorded.
Results: The dosimetric analysis revealed that IMRT provided superior dose conformity and better sparing of organs at risk (OARs) compared to 3D-CRT. Specifically, IMRT allowed for a statistically significant reduction of the mean doses to the bladder and rectum while maintaining adequate target volume coverage. However, planning IMRT cases took approximately twice as long as 3D-CRT (mean 65 minutes versus 31 minutes).
Conclusion: This study demonstrates the feasibility of implementing IMRT in a Nepalese setting, showcasing its potential to improve treatment precision and reduce radiation exposure to critical organs compared to 3D-CRT. Although IMRT requires more extensive planning and delivery time, its superior dosimetric outcomes could profoundly improve cervical cancer care in Nepal. This underscores the importance of continued research and investment in advanced radiotherapy techniques within resource-limited settings.