title: American Brachytherapy Society: Brachytherapy treatment recommendations for locally advanced cervix cancer for low-income and middle-income countries.
abstract: Most cervix cancer cases occur in low-income and middle-income countries (LMIC), and outcomes are suboptimal, even for early stage disease. Brachytherapy plays a central role in the treatment paradigm, improving both local control and overall survival. The American Brachytherapy Society (ABS) aims to provide guidelines for brachytherapy delivery in resource-limited settings.
  
  
  
  A panel of clinicians and physicists with expertise in brachytherapy administration in LMIC was convened. A survey was developed to identify practice patterns at the authors' institutions and was also extended to participants of the Cervix Cancer Research Network. The scientific literature was reviewed to identify consensus papers or review articles with a focus on treatment of locally advanced, unresected cervical cancer in LMIC.
  
  
  
  Of the 40 participants invited to respond to the survey, 32 responded (response rate 80%). Participants were practicing in 14 different countries including both high-income (China, Singapore, Taiwan, United Kingdom, and United States) and low-income or middle-income countries (Bangladesh, Botswana, Brazil, India, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). Recommendations for modifications to existing ABS guidelines were reviewed by the panel members and are highlighted in this article.
  
  
  
  Recommendations for treatment of locally advanced, unresectable cervical cancer in LMIC are presented. The guidelines comment on staging, external beam radiotherapy, use of concurrent chemotherapy, overall treatment duration, use of anesthesia, applicator choice and placement verification, brachytherapy treatment planning including dose and prescription point, recommended reporting and documentation, physics support, and follow-up.
authors.affiliation: Duke University, Durham, NC. Electronic address: Gita.suneja@icloud.com.
authors.forename: Gita
authors.initials: G
authors.lastname: Suneja
authors.affiliation: University of California San Diego, San Diego, CA.
authors.forename: Derek
authors.initials: D
authors.lastname: Brown
authors.affiliation: Pamela Youde Nethersole Eastern Hospital, Hong Kong.
authors.forename: Amy
authors.initials: A
authors.lastname: Chang
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Beth
authors.initials: B
authors.lastname: Erickson
authors.affiliation: International Atomic Energy Agency, Vienna, Austria.
authors.forename: Elena
authors.initials: E
authors.lastname: Fidarova
authors.affiliation: University of Pennsylvania, Philadelphia, PA; Princess Marina Hospital, Gaborone, Botswana.
authors.forename: Surbhi
authors.initials: S
authors.lastname: Grover
authors.affiliation: Tata Memorial Center, Mumbai, India.
authors.forename: Umesh
authors.initials: U
authors.lastname: Mahantshetty
authors.affiliation: Kaiser Permanente, Santa Clara, CA.
authors.forename: Subir
authors.initials: S
authors.lastname: Nag
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Kailash
authors.initials: K
authors.lastname: Narayan
authors.affiliation: Gaborone Private Hospital, Gaborone, Botswana.
authors.forename: Memory
authors.initials: M
authors.lastname: Bvochora-Nsingo
authors.affiliation: Instituto Nacional de Cancer- INCA, Rio de Janeiro, Brazil.
authors.forename: Celia
authors.initials: C
authors.lastname: Viegas
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: Akila N
authors.initials: AN
authors.lastname: Viswanathan
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Ming Yin
authors.initials: MY
authors.lastname: Lin
authors.affiliation: University of Utah, Salt Lake City, UT.
authors.forename: David
authors.initials: D
authors.lastname: Gaffney
mesh_terms: D001918:Brachytherapy / Q000379:methods* / Q000592:standards; D003906:Developing Countries; D005260:Female; D006295:Health Resources; D006801:Humans; D018787:Radiation Oncology; D011878:Radiotherapy; D011879:Radiotherapy Dosage; D012955:Societies, Medical; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy*
keywords: Brachytherapy; Cervix cancer; Consensus guidelines; Global oncology; Low-resource setting