Author: Kevin Albuquerque, Ti Bai, Yesenia Gonzalez, Brian A. Hrycushko, Zohaib Iqbal, Paul M. Medin, Shanshan Tang 👨🔬
Affiliation: Department of Radiation Oncology, UT Southwestern Medical Center 🌍
Purpose: Cervical cancer remains one of the most common and significant gynecological (GYN) malignancies globally, often presenting at advanced stages where radiation therapy and high-dose-rate (HDR) brachytherapy are the standard of care. HDR brachytherapy demands exceptional precision in treatment planning and relies on robust quality assurance measures to ensure optimal outcomes. We developed a web-based application to enhance the treatment process for GYN cancer patients undergoing HDR brachytherapy at our institution.
Methods: The application summarizes dosimetric metrics from multiple treatment fractions, focusing on target volume coverage, dose to organs-at-risk (OAR) and volumetric change. By aligning these metrics with EMBRACE II guideline recommendations, the webapp enables continuous monitoring of treatment quality and flags deviations that may require corrective actions. Meanwhile, the GYN webapp supports weekly peer review processes, facilitates longitudinal tracking of treatment performance, and provides actionable insights to aid clinical decision-making. This application empowers a multidisciplinary team to efficiently identify suboptimal plans, optimize treatment strategies, and improve the overall quality of care.
Results: Dosimetric metrics that deviate from the aim and limit dose levels defined by EMBRACE II are highlighted in red and orange, respectively. This visual indicator serves as a prompt for physicist and physician to review flagged case in depth. The webapp allows detailed exploration of individual patient data. Users can input external beam and brachytherapy prescription to access comprehensive dosimetric and volumetric data for each treatment fraction. Additionally, the application calculates EQD2 values to support clinical decision-making.
Conclusion: The implementation of the GYN webapp enhances the ability of physicists and physicians to identify suboptimal plans and provides focus for improvement of future fractions. This structured approach ensures that HDR GYN treatment planning is precise and efficient over a course of brachytherapy, contributing to better patient outcomes.