Dados do Trabalho

Título

3D BRACHYTHERAPY REDUCES CERVICAL CANCER MORTALITY: HOW TO IMPLEMENT IT

Introdução

Cervical cancer is the third most common neoplasm in women in Brazil. Most patients have advanced, inoperable disease, receiving chemoradiotherapy and brachytherapy.
Brachytherapy provides large part of the dose, and no technology replaces it, otherwise, studies have shown poorer survival when attempted. Planning use x-ray, standard 40 years ago, has risk of uterus perforation and high complication rates of rectal bleeding, urine, intestinal obstruction. Tomography brachytherapy (CT) planning increases local control and survival by 10 to 30% and decreases toxicity, from 25% to 2%. Increasing disease survival meets SDG 3, which addresses a 1/3 reduction in premature mortality from cancer.

Objetivo

To review aspects of implementation of a new technology in a resource limited scenario during COVID 19 pandemics, establish a workflow and publicize it to encourage in others facilities.

Método

Descritive analisys of the implementation process or 3D-brachytherapy in a tertiary hospital. and work flow. description.

Resultados

Advocacy for women cancer cause is the first step to get financial resources and team engagement. Brachytherapy is a multidisciplinary treatment. Team training in pandemics require additional efforts and distance learning tools use. Effective communication between physician, physicists, nurse, anesthesiologists, CT scan technicians, stretcher bearer is crucial to succeed in all steps of process. It is necessary to overcome structural challenges, in which CT are far from brachytherapy equipment. An alternative is to use a stretcher that immobilizes the intrauterine applicators on the patient and has hydraulic mechanism, allowing image acquisition safely in sectors far from where brachytherapy will be provided. It was established standard operational procedure for simulation, rectal and vesical filling, sedation, patient transport care with applicators insert into uterus, pain management, image acquisition, protocols, treatment volumes definition, planning aspects.

Conclusão

Efforts to advocacy for better women cancer care and publicizing this process can help other centers to overcame similar challenges. 3D-brachytherapy will ensure that patients with cervical cancer live longer, with less actinic rectit, cystitis, fewer hospital admissions just by changing the way it is planned brachytherapy

Palavras-chave

cervical cancer, brachytherapy, conformal brachytherapy, cancer mortality