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Cancer Institute of Guyana acquires brachy system to boost better outcomes for Guyanese women with cervical cancer

HIGHLIGHTS

  • Cervical cancer alone accounts for about 100 deaths among Guyanese women each year, making it the leading cause of mortality among local women.[1]
  • Cervical cancer is the second most common cancer among Guyanese women and the first most common among women aged 15-44.[2]
  • The significance of brachytherapy at will have a profound impact for inhabitants of Guyana and for cervical cancer patients in the greater region.

Before March 2017, doctors at Cancer Institute of Guyana (CIG, Georgetown, Guyana, South America) assumed that once their patients with cervical cancer completed a course of external beam radiation therapy (EBRT) they would seek out intracavitary high dose rate (HDR) brachytherapy boost, the recommended next step in treating the disease. However, because brachytherapy services could only be found in neighboring Brazil or Venezuela, or in a Caribbean island such as Trinidad, many of their patients didn’t have the time or money to make the journey and therefore simply didn’t receive brachytherapy. What happened next was predictable.

“The women were returning to CIG with disease recurrence – bilateral parametrium involvement and hydronephrosis. These complications arose because they didn’t receive the complete cervical cancer treatment,” says Viqar Syed, MD, managing director of India’s Super Oncology Group (SOG). Over a two-year period, SOG worked with Elekta, the Guyanese government and the USA’s Global Imaging Services (GIS) to purchase and site Elekta’s Digital Brachytherapy Afterloading Platform.

CIG – established as a non-profit organization in 2006 to address the urgent need for cancer treatment services in a country plagued by the disease – is a collaboration between Guyana’s Ministry of Health and GIS.

Situation for women with cervical cancer is “looking up”

“I did a small research study at CIG on the recurrence rate for women who received EBRT but no brachytherapy boost,” adds SOG radiation oncologist Sayan Chakraborty, MD, who was sent to CIG to serve as the Institute’s (and Guyana’s) sole radiation oncologist. “The recurrence rate was 38 percent. It’s very sad. If you return with a recurrence the prognosis is very dismal. But with the Elekta brachytherapy HDR treatment, things are really looking up.”

On February 18, CIG launched its HDR brachytherapy program with the treatment of a 56-year-old woman with stage III endometrial cancer. Her post-operative intra-cavitary brachytherapy treatment was three fractions of 7 Gy each. The first patient with cervical cancer was a 60-year-old woman with stage IIB disease, who began treatment on April 28 and who received three fractions of 7 Gy each to complete her therapy. Since then, an additional seven patients have received brachytherapy.

“The performance of the Elekta afterloader was very smooth for these first patients,” Dr. Chakraborty says. “Boost treatment with brachytherapy is so important for these patients as I said. You can give EBRT only to a certain dose, above which you risk damaging the bladder and surrounding organs. However that also means you can’t give a tumoricidal dose. Intracavitary brachytherapy solves that problem by concentrating a high dose of therapeutic radiation right at the cancer site.”

A new era for cervical cancer patients in Guyana

Dr. Syed, who also serves as Managing Director, Pinnacle Cancer Centers in India and internationally, says he chose microSelectron for CIG because of his familiarity with the system in India.

“We felt it would be more of a workhorse for the region,” he observes. “And, we realized that Elekta has strong customer support in the Caribbean and South America, which is extremely important.

Secondly, the system’s source utilization and number of cycles were excellent, and the Oncentra Brachy treatment planning system could help us create great dose distributions and is quite user-friendly for the clinicians and physicists.”

He estimates that CIG will perform intracavitary brachytherapy for four to five patients with gynecological cancer per week. Guyana’s public healthcare system subsidizes all treatment costs for citizens of the country.

On the horizon at CIG is the possibility to integrate interstitial treatments into its brachytherapy program. The training for interstitial brachytherapy will be done at Long Beach Memorial Cancer Institute (Long Beach, CA, USA), where the pioneer of modern brachytherapy – Professor Nisar Syed – will train CIG’s Dr. Chakraborty. During interstitial brachytherapy, devices containing radioactive material are inserted directly into body tissue via needles and catheters. This variation of brachytherapy is useful in getting therapeutic radiation closer to the disease extensions common in advanced cervical cancer.

“If we assess that interstitial brachytherapy could be very beneficial in this region we would add that technique to our brachytherapy services,” Dr. Syed remarks. “We also would consider adding Elekta’s new Venezia™ applicator for applying both intracavitary and interstitial brachytherapy for the same patient – in an attempt to maximize the therapy’s impact for women with cancers that extend beyond the cervix into the parametrium.

“But for now, we’re moving slowly with the HDR program, focusing on GYN cancers to begin with and just trying to understand the needs in the region,” he continues.

“The significance of brachytherapy as we practice it right now at CIG cannot be overstated. It will have a profound impact for inhabitants of Guyana and for cervical cancer patients in the greater region.”

Radiotherapy renaissance in Guyana

Dr. Syed and Super Oncology Group (SOG, India) plan to engage with Cancer Institute Guyana (CIG) to establish multidisciplinary cancer care services, including the replacement of its existing Siemens linear accelerator with a more advanced system with dual energies and IMRT capabilities, with the option to upgrade the unit for SRS/SRT/SBRT.

Guyana is currently experiencing an increase in its cancer burden, specifically cancers of the breast, cervix and head-and-neck, in addition to cancers of the lung, liver, colorectal and metastatic disease. “This situation calls for the country to launch advanced and modernized systems, programs and procedures for meeting this challenge,” Dr. Syed says.

Pinnacle Cancer centers international, under the professional leadership of SOG, will strive to provide the best clinical resources needed in the future and to partner with Guyana’s Ministry of Health to facilitate the acquisition of professional staff, including oncologists, oncology nurses, physicists and technologists.

“The pillar of cancer care has always been early detection and an early curative approach to comprehensive care,” he reiterates . “The Pinnacle group emphasizes the golden rule of ‘’community surveillance, early detection and cancer education for an effective and comprehensive approach to cancer care in the communities it serves.”

  1. “Guyana has the highest incidence of cancer mortality in the Region,” http://www.kaieteurnewsonline.com/2017/02/10/guyana-has-highest-incidence-of-cancer-mortality-in-the-region/
  2. “Guyana: Human Papillomavirus and Related Cancers, Fact Sheet 2017,” http://www.hpvcentre.net/statistics/reports/GUY_FS.pdf

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