title: The changing landscape of brachytherapy for cervical cancer: a Canadian practice survey.
abstract: BACKGROUND
  We documented changes in practice from 2009 to 2012 for cervical cancer brachytherapy in Canada.
  
  
  METHODS
  Centres with gynecologic brachytherapy services were sent an e-mail questionnaire querying their 2012 practice. Responses are reported and compared with practice patterns identified in a similar survey for 2009.
  
  
  RESULTS
  The response rate was 77% (24 of 31 centres). Almost all use high-dose-rate brachytherapy (92%); low-dose-rate brachytherapy has been completely phased out. Most continue to move patients from the site of applicator insertion to the radiation treatment simulation suite (75%) or to a diagnostic imaging department (29%), or both. In 2012, the imaging modalities used for dose specification were computed tomography [ct (75%)], magnetic resonance imaging [mri (38%)], plain radiography (21%), and cone-beam ct (8%). The number of institutions using mri guidance has markedly increased during the period of interest (9 vs. 1). Most respondents (58% vs. 14%) prescribed using guidelines from the Groupe Européen de Curiethérapie and the European Society for Therapeutic Radiology and Oncology, but they also used point A as a reference. Commonly used high-dose radiation regimens included 30 Gy in 5 fractions and 24 Gy in 3 fractions.
  
  
  CONCLUSIONS
  In Canada, image-guided brachytherapy for cervical cancer continues to evolve. Although ct-based imaging remains the most commonly used modality, many centres have adopted mri for at least 1 brachytherapy treatment. More centres are using fewer fractions and a slightly lower biologically effective dose, but are still achieving EQD2 (2-Gy equivalent) doses of 80-90 Gy in combination with external-beam radiation therapy.
authors.affiliation: Department of Oncology, Tom Baker Cancer Centre, Calgary, AB;
authors.forename: T
authors.initials: T
authors.lastname: Phan
authors.affiliation: Department of Oncology, Tom Baker Cancer Centre, Calgary, AB;
authors.forename: L
authors.initials: L
authors.lastname: Mula-Hussain
authors.affiliation: Department of Radiation Oncology, Christian Medical College, Vellore, South India;
authors.forename: S
authors.initials: S
authors.lastname: Pavamani
authors.affiliation: Department of Radiation Oncology, Northeast Cancer Centre, Sudbury, ON;
authors.forename: A
authors.initials: A
authors.lastname: Pearce
authors.affiliation: Department of Radiation Oncology, London Regional Cancer Program, London, ON;
authors.forename: D
authors.initials: D
authors.lastname: D'Souza
authors.affiliation: Department of Radiation Oncology, Nova Scotia Cancer Centre, Halifax, NS.
authors.forename: N G
authors.initials: NG
authors.lastname: Patil
authors.affiliation: Department of Oncology, Tom Baker Cancer Centre, Calgary, AB;
authors.forename: L
authors.initials: L
authors.lastname: Traptow
authors.affiliation: Department of Oncology, Tom Baker Cancer Centre, Calgary, AB;
authors.forename: C M
authors.initials: CM
authors.lastname: Doll
keywords: Cervical cancer; brachytherapy; radiation oncology