Dosimetric Studies in Image-Guided Adaptive Brachytherapy in Gynecological Cancers: A Journey to Successful Implementation

Implementation of Image-guided adaptive brachytherapy (IGABT) in India and other developing countries is a major challenge due to the resources, expertise and financial constraints. The basis of this thesis was to address various issues related to transition and successful implementation of IGABT in clinical routine.[1] Tata Memorial Hospital (TMH), Mumbai has a long tradition of being active in international collaborative research. Various fellowship programs for both clinicians and physicists have been the basis for successful collaborative research. Within many such projects, TMH is one of largest participating centers in the ongoing multi-centric collaborative international study on magnetic resonance (MR) imaging-guided brachytherapy in locally advanced cervical cancer. The study was designed to evaluate the dose-effect relationship on local control/morbidity of the tumor and toxicities of organs at risks (OAR) when MR images were used for cervical cancer brachytherapy. This thesis reiterates that, like any other advanced techniques, IGABT too requires systematic clinical implementation taking into account various technological, dosimetrical, and clinical issues. Systematic transition and appropriate implementation of IGABT for locally advanced cervical cancers may result in better outcome.