title: International brachytherapy practice patterns: a survey of the Gynecologic Cancer Intergroup (GCIG).
abstract: OBJECTIVE
  To determine current practice patterns with regard to gynecologic high-dose-rate (HDR) brachytherapy among international members of the Gynecologic Cancer Intergroup (GCIG) in Japan/Korea (Asia), Australia/New Zealand (ANZ), Europe (E), and North America (NAm).
  
  
  METHODS
  A 32-item survey was developed requesting information on brachytherapy practice patterns and standard management for Stage IB-IVA cervical cancer. The chair of each GCIG member cooperative group selected radiation oncology members to receive the survey.
  
  
  RESULTS
  A total of 72 responses were analyzed; 61 respondents (85%) used HDR. The three most common HDR brachytherapy fractionation regimens for Stage IB-IIA patients were 6 Gy for five fractions (18%), 6 Gy for four fractions (15%), and 7 Gy for three fractions (11%); for Stage IIB-IVA patients they were 6 Gy for five fractions (19%), 7 Gy for four fractions (8%), and 7 Gy for three fractions (8%). Overall, the mean combined external-beam and brachytherapy equivalent dose (EQD2) was 81.1 (standard deviation [SD] 10.16). The mean EQD2 recommended for Stage IB-IIA patients was 78.9 Gy (SD 10.7) and for Stage IIB-IVA was 83.3 Gy (SD 11.2) (p = 0.02). By region, the mean combined EQD2 was as follows: Asia, 71.2 Gy (SD 12.65); ANZ, 81.18 (SD 4.96); E, 83.24 (SD 10.75); and NAm, 81.66 (SD, 6.05; p = 0.02 for Asia vs. other regions).The ratio of brachytherapy to total prescribed dose was significantly higher for Japan (p = 0.0002).
  
  
  CONCLUSIONS
  Although fractionation patterns may vary, the overall mean doses administered for cervical cancer are similar in Australia/New Zealand, Europe, and North America, with practitioners in Japan administering a significantly lower external-beam dose but higher brachytherapy dose to the cervix. Given common goals, standardization should be possible in future clinical trials.
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA. aviswanathan@lroc.harvard.edu
authors.forename: Akila N
authors.initials: AN
authors.lastname: Viswanathan
authors.forename: Carien L
authors.initials: CL
authors.lastname: Creutzberg
authors.forename: Peter
authors.initials: P
authors.lastname: Craighead
authors.forename: Mary
authors.initials: M
authors.lastname: McCormack
authors.forename: Takafumi
authors.initials: T
authors.lastname: Toita
authors.forename: Kailash
authors.initials: K
authors.lastname: Narayan
authors.forename: Nicholas
authors.initials: N
authors.lastname: Reed
authors.forename: Harry
authors.initials: H
authors.lastname: Long
authors.forename: Hak-Jae
authors.initials: HJ
authors.lastname: Kim
authors.forename: Christian
authors.initials: C
authors.lastname: Marth
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Lindegaard
authors.forename: Annmarie
authors.initials: A
authors.lastname: Cerrotta
authors.forename: William
authors.initials: W
authors.lastname: Small
authors.forename: Edward
authors.initials: E
authors.lastname: Trimble
mesh_terms: D001315:Australia; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D019583:Dose Fractionation, Radiation; D005060:Europe; D005260:Female; D006176:Gynecology; D019538:Health Care Surveys; D006801:Humans; D038622:Internationality; D007564:Japan; D009367:Neoplasm Staging; D009520:New Zealand; D009656:North America; D010818:Practice Patterns, Physicians'; D056910:Republic of Korea; D012955:Societies, Medical; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy*