20.05.21
From the left: Doctors from Aarhus University Hospital Jacob Lindegaard and Lars Ulrik Fokdal and hospital physicist Kari Tanderup. Together, they have developed internal radiation therapy for patients with cervical cancer. Jacob Lindegaard shows the plastic needles uses to precisely treat the cancer tumour (Photo: Tonny Foghmar).
Aarhus University Hospital is a pioneer setting new standards for use of internal radiation treatment in patients with cervical cancer. Results are presented in a large international study.
MR scans are used to guide the implantation of plastic needles with a radioactive source directly into a cancer tumour at the uterine cervix. This is the principle behind internal radiation therapy – also called brachytherapy – used in the treatment of women with advanced cervical cancer.
For years, Aarhus University Hospital has been pioneers in image-guided brachytherapy. MR scans are used to find the precise location for the application of radiation therapy. The method is becoming widespread across the world. Today, experts from Aarhus University Hospital teach both Danish colleagues and colleagues from abroad how to use the technique at their own hospitals.
Markedly improved disease control
The internationally acknowledged scientific journal The Lancet has recently published the results of the largest study so far in the field as the culmination of a long-standing collaboration coordinated by Aarhus University Hospital and Medical University of Vienna in Austria.
- Image-guided brachytherapy in patients with cervical cancer markedly improves control of the disease and it also has fewer side effects than traditional radiation therapy, says Jacob Lindegaard, Consultant at Department of Oncology, Aarhus University Hospital, who treats patients with brachytherapy in his daily work.
- Previously, about one third of patients with locally advanced cervical cancer died within a period of five years after the diagnosis. Today, this only applies to about one fifth of the patients. An important reason for this improvement is undoubtedly that MR brachytherapy will provide local control of the cervical cancer in 90-95% of cases.
Widespread use all over the world
The international study is named EMBRACE I, and researchers have now started to include patients for the EMBRACE II study where knowledge from EMBRACE I is implemented in detailed treatment protocols on acceptable radiation doses for normal tissue and desired radiation doses to treat the patient’s cancer tumour. Patients are continuously followed to assess disease control and side effects, including quality of life.
The EMBRACE collaboration is particularly focused on spreading the best possible quality of the radiation treatment for cervical cancer to the rest of the world.
- The consortium has been the driving force behind several international guidelines and has trained 48 hospitals across the world – 21 countries in Europe, North America, Asia and Australia – in applying this new treatment. Many of the departments now spread the technique in their local regions and countries, says professor Kari Tanderum, who is involved in the EMBRACE group from Aarhus University Hospital and co-author of the article in The Lancet Oncology together with Jacob Lindegaard and Lars Fokdal, Consultant at Department of Oncology.
The EMBRACE group now moves on to the next generation of clinical studies, which will hopefully bring down the extent of side effects and increase survival in patients with locally advanced cervical cancer.
- Moreover, they work on introducing MR-guided radiation and brachytherapy in other gynaecological cancers.
First hospital in the Nordic countries
Aarhus University Hospital was the first hospital in the Nordic countries to introduce MR-guided brachytherapy in 2005. The hospital is still in the lead today.
This is reflected in i.e., a new scoring system (T-score) for systematic and multidisciplinary integration of information from gynaecological examinations and MR scans into one score, which can be used to predict disease control and survival with a high probability. Moreover, the system provides doctors with information to improve radiation treatment.
Behind the research result:
Study type:
Prospective international observational cohort study.
Collaborators:
EMBRACE Cooperative Group: Currently 48 departments in Europe, USA, Canada, India, Southeast Asia and Australia with expertise in advanced radiation therapy and MR-guided brachytherapy.
External financing:
The EMBRACE Cooperative Group is supported by Medical University of Vienna, Aarhus University, Danish Cancer Society, Elekta AB and Varian Medical Systems. The T-score project is supported by Danish Cancer Association and Central Denmark Region Health Research Fund.
Conflicts of interest:
Jacob Lindegaard has received a fee from Varian Medical Systems for teaching of a course in MR-guided brachytherapy for patients with cervical cancer.
Read the scientific article:
https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(20)30753-1.pdf
Further information:
Jacob Chr. Lindegaard, Consultant, DMSci, Associate professor, Department of Oncology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Tel.: +45 4046 5324, E-mail: jacolind@rm.dk