High-dose-rate afterloading brachytherapy in carcinoma of the uterine cervix

The Brachytron has been used in the University of California at San Diego Medical Center since 1970 as one method of treating gynecological malignancies. This machine contains a high intensity cobalt 60 remote afterloading cycling source used for intracavitary brachytherapy. One hundred twenty-seven patients with epithelial carcinoma of the cervix are available for analysis of 5-year survival, and 176 are analyzed for treatment complications two years following therapy. Five year survival figures for FIGO-staged patients treated with external beam pelvic irradiation and intracavitary Brachytron treatments are as follows: Stage I, 89%; Stage II, 58%; Stage III, 33%, and two of five patients Stage IVa. Rectal complications graded moderate or severe (M, S) were dose-related and gradually decreased over the years as techniques improved. Complications from early results in 1970-1972 (24% M, 10% S) were reduced to lower levels in 1976-1979 (14% M, 4% S). The Brachytron offers the advantage of rapid dose delivery. Thus, patients can be treated in an outpatient setting, avoiding the cost of hospitalization and the risks of anesthesia. The Brachytron also offers virtually complete radiation safety to all attending medical personnel. With survival and complication figures similar to those reported for patients treated with conventional low-dose-rate brachytherapy, the Brachytron represents an effective alternate mode of therapy for uterine carcinoma.     

High-dose-rate Rotte "Y" applicator brachytherapy for definitive treatment of medically inoperable endometrial cancer: 10-year results

PURPOSE: To assess the intermediate clinical outcomes of medically inoperable patients with endometrial cancer treated with definitive Rotte "Y" applicator high-dose-rate brachytherapy (HDRB) over a 10-year period. METHODS AND MATERIALS: Forty-nine inoperable patients were treated with HDRB from 1997 to 2007. Forty three (84%) were markedly obese (body mass index >35 kg/m(2)). Thirty-one patients (63.3%) underwent two-dimensional treatment planning, whereas 18 patients (36.7%) underwent three-dimensional treatment planning. Thirty five of the patients (71.4%) were first treated with external beam radiotherapy (EBRT). For patients receiving EBRT in addition to HDRB, the median Y-applicator dose was 20 Gy in 5 fractions; for patients receiving HDRB alone it was 35 Gy in 5 fractions. All patients received two Y-applicator treatments per day. RESULTS: Median follow-up time for all patients was 33 months. Acute HDRB toxicities were limited to Grade 1 and 2 occurring in 5 patients. One patient had a myocardial infarction. Four patients had late Grade 2 or 3 toxicity. Three patients had local recurrence (median time to recurrence, 16 months). The 3- and 5-year actuarial cause-specific survival rates were 93% and 87%, respectively; the overall survival rate was 83% and 42%, respectively, at 3 and 5 years. CONCLUSIONS: Twice-daily HDRB using a Y-applicator is a well-tolerated and efficacious regimen for the definitive treatment of medically inoperable patients with early-stage endometrial cancer. The recent incorporation of three-dimensional treatment planning has the potential to further decrease treatment morbidities.     

High-dose-rate brachytherapy using molds for oral cavity cancer: The technique and its limitations

Background. With the availability of a high-dose-rate (HDR) remote afterloading device, a Phase I/11 protocol was initiated at our institution to assess the toxicity and efficacy of HDR intracavitary brachytherapy, using molds, in the treatment of squamous cell carcinomas of the oral cavity. Methods. Eight patients with squamous cell carcinoma of the oral cavity were treated by the technique. The primary sites of the tumors were the buccal mucosa, oral floor, and gingiva. Two of the buccal mucosal cancers were located in the retromolar trigon. For each patient, a customized mould was fabricated, in which two to four afterloading catheters were placed for an ¹⁹²Ir HDR source. Four to seven fractions of 3–4 Gy, 5 mm below the mould surface, were given following external radiation therapy of 40–60 Gy/2 Gy. The total dose of HDR brachytherapy ranged from 16 to 28 Gy. Results. Although a good initial complete response rate of 7/8 (88%) was achieved, there was local recurrence in four of these seven patients. Both of the retromolar trigon tumors showed marginal recurrence. No serious (e.g., ulcer or bone exposure) late radiation damage has been observed thus far in the follow up period of 15–57 months. Conclusions. High-dose-rate brachytherapy using the mold technique seems a safe and useful method for selected early and superficial oral cavity cancer. However, it is not indicated for thick tumors and/or tumors located in the retromolar trigon.     

宫颈癌三维近距离治疗中两种常用施源器的剂量学比较

目的 对比研究环形施源器(Nucletron#090.617)和三管施源器(Nucletron#189.730)对宫颈癌患者三维近距离治疗受照剂量的影响。 方法 选取已完成治疗的根治性宫颈癌Ⅱ_B—Ⅳ_A期患者 40例,20例采用环形施源器,另外 20例采用三管施源器,分别统计三维近距离治疗计划中靶区 V_150% 、D₁₀₀和膀胱、直肠、小肠 D_{2 cc}。采用立独样本t检验方法对比分析两种施源器在宫颈癌三维近距离治疗中CTV和OAR的剂量。 结果 环形施源器和三管施源器的靶体积分别为(66.04±13.86) cm³、(65.67±15.08) cm³(P=0.052)。环形施源器中 D₁₀₀、V_150%分别为(3.71±0.34) Gy、0.54±0.02;三管施源器中 D₁₀₀、V_150%分别为(3.37±0.49) Gy、0.56±0.04(P=0.016、0.034)。环形施源器中膀胱、直肠、小肠 D_{2 cc}分别为(4.33±0.39)、(3.38±0.30)、(3.04±1.02) Gy,三管施源器的分别为(2.93±1.27)、(2.95±0.80)、(3.41±0.57) Gy (P=0.000、0.037、0.171)。 结论 宫颈癌三维近距离治疗中环形施源器靶区的覆盖度优于三管施源器,而膀胱、直肠受量同时也高于三管施源器,但小肠受量无差异。临床治疗中主要还是根据肿瘤的位置、侵犯范围以及阴道的条件来选择施源器。     

High-dose-rate brachytherapy in the treatment of uterine cervix cancer. Analysis of dose effectiveness and late complications

This retrospective analysis aims to report results of patients with cervix cancer treated by external beam radiotherapy (EBR) and high-dose-rate (HDR) brachytherapy.

From September 1992 to December 1996, 138 patients with FIGO Stages II and III and mean age of 56 years were treated. Median EBR to the whole pelvis was 45 Gy in 25 fractions. Parametrial boost was performed in 93% of patients, with a median dose of 14.4 Gy. Brachytherapy with HDR was performed during EBR or following its completion with a dose of 24 Gy in four weekly fractions of 6 Gy to point A. Median overall treatment time was of 60 days. Patient age, tumor stage, and overall treatment time were variables analyzed for survival and local control. Cumulative biologic effective dose (BED) at rectal and bladder reference points were correlated with late complications in these organs and dose of EBR at parametrium was correlated with small bowel complications.

Median follow-up time was 38 months. Overall survival, disease-free survival, and local control at 5 years was 53.7%, 52.7%, and 62%, respectively. By multivariate and univariate analysis, overall treatment time up to 50 days was the only statistically significant adverse variable for overall survival (p = 0.003) and actuarial local control (p = 0.008). The 5-year actuarial incidence of rectal, bladder, and small bowel late complications was 16%, 11%, and 14%, respectively. Patients treated with cumulative BED at rectum points above 110 Gy₃ and at bladder point above 125 Gy₃ had a higher but not statistically significant 5-year actuarial rate of complications at these organs (18% vs. 12%, p = 0.49 and 17% vs. 9%, p = 0.20, respectively). Patients who received parametrial doses larger than 59 Gy had a higher 5-year actuarial rate of complications in the small bowel; however, this was not statistically significant (19% vs. 10%, p = 0.260).

This series suggests that 45 Gy to the whole pelvis combined with four fractions of 6 Gy to point A with HDR brachytherapy is an effective and safe fractionation schedule in the treatment of Stages II and III cervix cancer if realized up to 50 days. To decrease the small bowel complications, we decreased the superior border of the parametrial fields to the S2-S3 level and the total dose to 54 Gy.     

High-dose-rate versus low-dose-rate intracavitary brachytherapy for carcinoma of the cervix

High-dose-rate (HDR) remote afterloading intracavitary brachytherapy has been widely used in the treatment of carcinoma of the cervix in Europe and Asia since the 1960's. Recently, there has been an increase of interest in the use of this technique in North America. Most of the non-randomized studies suggest similar survival, local control, and complication rates using fractionated high-dose-rate remote afterloading intracavitary brachytherapy combined with external beam irradiation compared to historical or concurrent low-dose-rate (LDR) controls. However, the techniques as well as the dose fractionation schedules used in different institutions are variable. The optimal technique and dose fractionation scheme has yet to be established through systematic clinical trials.     

Predictive value of linear-quadratic model in the treatment of cervical cancer using high-dose-rate brachytherapy

: To determine whether a dose-response relationship exists between the biologic effective dose (BED) at Point A and the bladder and rectum and the clinical outcomes in our experience with external beam radiotherapy (EBRT) and high-dose-rate brachytherapy in the treatment of cervical carcinoma.

: This was a retrospective study. A total of 49 patients with cervical cancer were treated with a combination of EBRT (median 45 Gy, range 41.4–50.4) and high-dose-rate brachytherapy (median 18 Gy; range 18–19, in two fractions). Twenty-three patients received concomitant cisplatin-based chemotherapy. The cumulative BEDs were calculated at Point A (BED10) and at bladder and rectal reference points (BED3) using the linear-quadratic equation. The BED10 values, after incorporating a time factor (BED10tf) in the formula, were also calculated.

: In patients treated with RT alone, the local failure rate was 10% (1 of 10) and 19% (3 of 16) in patients receiving a BED10 >89 Gy10 or <89 Gy10 to Point A, respectively (p = 0.2). The corresponding local failure rates were 20% (3 of 15) and 0% (0 of 8) in patients treated with concomitant chemotherapy (p = 0.3). In patients treated with RT alone, the local failure rate was 7.7% (1 of 13) and 23% (3 of 13) in patients with a BED10tf >64 Gy10 or <64 Gy10 (p = 0.1), respectively. The median BED3 values at the rectal and bladder point was 95.5 Gy3 and 103.6 Gy3, respectively. Only 1 case of Grade 2 late rectal toxicity (2%) and no late bladder toxicity occurred.

: In patients treated with RT alone, a BED10 >89 Gy and a BED10tf >64 Gy indicated a trend toward a better local control rate. This difference was not observed in patients receiving chemotherapy. A BED3 <100 Gy3 was associated with negligible late toxicity. Although the BED10 in our study was about 10–15 Gy10 less than that in the published data, the 4-year local control rate of 80% and 83% and disease-free survival rate of 75% and 70% with and without chemotherapy, respectively, compare well with the rates in other studies in the literature.     

CT引导下宫颈复发癌挽救性组织间插植近距离治疗剂量学分析

目的 CT引导下组织间插植近距离治疗宫颈复发癌患者的新方法,分析其剂量学优势。方法 16例接受过手术和术后辅助性体外放疗的宫颈复发癌患者接受了CT引导下金属针植入的组织间插植治疗。给予高危临床靶区(HR-CTV)6 Gy 6次剂量。评价本次近距离治疗肿瘤靶区HR-CTV D90;之前的体外照射和本次近距离治疗累加的膀胱、直肠及乙状结肠D2 cm³值。结果 HR-CTV D90的平均值为(52.5±3.3) Gy。膀胱、直肠、乙状结肠累加D2 cm³分别为(85.6±5.8)、(71.6±6.4)、(69.6±5.9) Gy。每次近距离治疗金属针的平均使用量为(6.1±1.5)。实际1年OS、LC分别为81%、69%。结论 CT引导下组织间插植近距离治疗对宫颈复发癌具有很好的DVH参数和较小的并发症,或许临床是可行的,但其远期临床结果尚待进一步观察。     

CT引导徒手腔内联合插植自适应后装与传统A点后装治疗宫颈癌剂量比较

目的 探讨CT引导徒手腔内联合插植实现影像引导自适应后装(IGABT)相较于传统A点二维后装(CP)剂量学优势,明确其在宫颈癌治疗中的价值。方法 选取在中山大学肿瘤医院行全量放疗的宫颈癌患者 26例,每例患者行4次后装治疗。治疗时先徒手置入宫腔管及2根插植针,后增加插植针数量并调整方向、深度,分别行CT扫描获得2套图像。勾画高危临床靶区(HRCTV),A点和危及器官(直肠、膀胱及乙状结肠)。在2套图像上分别行CP和IGABT计划设计,并配对t检验、Wilcoxon检验两者剂量参数差异。结果 以CP计划的覆盖指数(CI)进行分组,A组(CI≥0.90)包含20个CP和对应IGABT计划,B组(CI<0.90)包含84个CP和对应IGABT计划。A组的HRCTV体积及肿瘤直径明显小于B组(46.7cm³∶62.1cm³,P<0.001及3.1cm∶4.4cm,P<0.0001)。IGABT显著提高所有及B组D90%及覆盖指数,降低膀胱剂量,减少A组乙状结肠剂量,并改善剂量适形度及均匀性。结论 IGABT能提高靶区覆盖、剂量适形度和均匀性,保护危及器官,且对肿瘤较大的患者仍有优势。     

Dosimetric comparison between CT-guided free-hand intracavity/interstitial adaptive brachytherapy and conventional point-A brachytherapy in the treatment of cervical cancer

Objective To analyze the dosimetric differences between CT-guided free-hand intracavity/interstitial brachytherapy[image-guided adaptive brachytherapy (IGABT)] and conventional point-A plan (CP) in the treatment of cervical cancer. Methods Twenty-six cervical cancer patients who received four cycles of IGABT in Sun Yat-sen University Cancer Center were enrolled in this study. Two sets of CT images were obtained before and after applicator adjustment to aid in the design of CP and IGABT plans. The high-risk clinical target volume (HRCTV), point A, and organs at risk (bladder, rectum, and sigmoid colon) were defined on CT images. CP and IGABT plans were designed on CT images. Parameter differences between CP and IGABT plans were analyzed with paired t-test and Wilcoxon test. Results According to the coverage index (CI) of CP, plans were divided into two groups:in group A (CI≥0.90), 20 CP and corresponding IGABT plans were included, and 84 CP and corresponding IGABT plans in group B (CI<0.90). The mean volume of HRCTV and mean tumor diameter in group A were significantly smaller than those in group B (46.7 cm³ vs. 62.1 cm³, P<0.001 and 3.1 cm vs. 4.4 cm, P<0.001). Compared with CP, IGABT significantly improved the value of D90% in all plans and group B, whereas lowered the bladder dose. IGABT also reduced the dose of sigmoid colon in group A. IGABT significantly improved conformal index and dose homogeneity index. Conclusions IGABT can significantly improve the target coverage, conformal index and dose homogeneity index, protect organs at risk. Compared with CP, IGABT has advantages in the treatment of patients with bulky tumor.     

Salvage high-dose-rate (HDR) brachytherapy for recurrent head-and-neck cancer

BACKGROUND: A significant portion of head-and-neck cancer patients will develop persistent or recurrent disease after definitive treatment. Radiation therapy is often used as definitive therapy or as an adjunct to surgery. Recurrent cancer of the head and neck in the previously irradiated field is, thus, a common occurrence and poses a therapeutic challenge. Some studies have evaluated low-dose-rate (LDR) brachytherapy as a therapeutic option, including a large case series with long-term follow-up by our own institution. High-dose-rate (HDR) brachytherapy offers therapeutic advantages over LDR brachytherapy. This study evaluates the local control and outcomes of patients with previously irradiated recurrent head-and-neck cancer treated with HDR interstitial brachytherapy. METHODS AND MATERIALS: Between 1997 and 2002, 30 patients who received prior radiation therapy for primary tumors of the head and neck were treated for biopsy-proven recurrent disease. All patients received previous radiation as definitive therapy alone or as adjunct to surgery. All patients were inoperable, refused surgery, or had gross residual disease after salvage surgery for their recurrent disease. Thirty-six sites on the 30 patients were implanted by application of high-dose-rate interstitial brachytherapy techniques with mean tumor dose of 34 Gy (18-48 Gy) in twice daily fractions of 300 to 400 cGy per fraction. RESULTS: At a minimum follow-up of 12 months, local tumor control was achieved in 69% of implanted sites. Disease-specific survival at 1 and 2 years was 54% and 45%, respectively. Overall survival at 1 and 2 years was 56% and 37%, respectively. Grade 3/4 late complications occurred in 16% of the patients. No fatal complications occurred. CONCLUSION: HDR brachytherapy can play an important role in the salvage treatment of previously irradiated recurrent head-and-neck cancer. This study shows that comparable results are obtained by HDR brachytherapy with fewer late complications than were indicated by previously reported data for LDR brachytherapy.     

MRI-based low dose-rate brachytherapy experience in locally advanced cervical cancer patients initially treated by concomitant chemoradiotherapy

Purpose

To retrospectively assess the physics contributions and the clinical outcome with preliminary 3D MRI-guided low dose-rate (LDR) intracavitary brachytherapy (BT) experience in locally advanced cervical cancer patients.

Patients and methods

Eighty-four patients with primary locally advanced cervical carcinoma were analyzed. The median tumoral cervical volume was 48.0 cc (range 1-468 cc). Twenty-four patients (53%) had histological and/or radiological pelvic involvement. After pelvic ± paraaortic concomitant chemoradiation, a LDR BT boost was delivered to a 3D MRI-based clinical target volume taking into account dose volume constraints for critical organs and optimization of target volume coverage.

Results

With a median follow-up of 53 months (range 31-79 months), the 4-year overall survival and disease-free survival rates were 57 (95%CI, 43-69) and 52% (95%CI, 40-64), respectively. Adding EBRT and LDR using EQD2 model, the median D₁₀₀ and D₉₀ for the IR-CTV were 56.5 Gy_α/β10 (range 37-83 Gy_α/β10) and 69 Gy_α/β10 (range 52-113 Gy_α/β10), respectively. For HR-CTV, the median D₁₀₀ and D₉₀ were 67 Gy_α/β10 (range 47-119 Gy_α/β10) and 79 Gy_α/β10 (range 53-122 Gy_α/β10), respectively. Thirty-nine late complications were observed in 28 patients (33.3%): 13 bladder, 7 rectal, 5 small bowel, 4 urethral, 3 colic, 2 vaginal, 1 pelvic fibrosis, and 4 others. Four grade 3 delayed complications were observed and no grade 4 complication occurred.

Conclusions

Applying an individual treatment planning with 3D MRI-guided LDR brachytherapy appears to be feasible and efficient for patients with locally advanced cervical cancer in routine clinical practice.     

MRI引导下的宫颈癌三维后装治疗进展

宫颈癌是造成全球女性肿瘤患者死亡的主要原因之一,放疗是宫颈癌的主要治疗手段,而后装治疗是宫颈癌放疗不可缺少的组成部分,外照射联合后装治疗适用于无远处转移的各期初治或复发宫颈癌患者。MRI具有良好的软组织分辨率,在精确靶区范围、保护OAR以及改善患者临床结局等方面有着独特优势;近来许多研究证实了MRI引导下的宫颈癌三维后装的可行性及优越性。本文主要从相关MR成像技术、施源器选择、靶区勾画与评估以及MRI引导下的三维后装治疗所带来的临床效应等方面进行阐述。     

宫颈癌术后近距离治疗的研究进展

放疗为宫颈癌术后辅助治疗的重要组成部分,随着放疗技术的发展,近距离治疗越来越多的应用于宫颈癌术后患者,多用作外照射的后期加量。本文将对宫颈癌术后放疗指征及近距离治疗应用情况予以阐述。     

Image-based brachytherapy for cervical cancer

Cervical cancer is the third most common cancer in women worldwide; definitive radiation therapy and concurrent chemotherapy is the accepted standard of care for patients with node positive or locally advanced tumors > 4 cm. Brachytherapy is an important part of definitive radiotherapy shown to improve overall survival. While results for two-dimensional X-ray based brachytherapy have been good in terms of local control especially for early stage disease, unexplained toxicities and treatment failures remain. Improvements in brachytherapy planning have more recently paved the way for three-dimensional image-based brachytherapy with volumetric optimization which increases tumor control, reduces toxicity, and helps predict outcomes. Advantages of image-based brachytherapy include: improved tumor coverage (especially for large volume disease), decreased dose to critical organs (especially for small cervix), confirmation of applicator placement, and accounting for sigmoid colon dose. A number of modalities for image-based brachytherapy have emerged including: magnetic resonance imaging (MRI), computed tomography (CT), CT-MRI hybrid, and ultrasound with respective benefits and outcomes data. For practical application of image-based brachytherapy the Groupe Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology Working Group and American Brachytherapy Society working group guideline serve as invaluable tools, additionally here-in we outline our institutional clinical integration of these guidelines. While the body of literature supporting image-based brachytherapy continues to evolve a number of uncertainties and challenges remain including: applicator reconstruction, increasing resource/cost demands, mobile four-dimensional targets and organs-at-risk, and accurate contouring of “grey zones” to avoid marginal miss. Ongoing studies, including the prospective EMBRACE (an international study of MRI-guided brachytherapy in locally advanced cervical cancer) trial, along with continued improvements in imaging, contouring, quality assurance, physics, and brachytherapy delivery promise to perpetuate the advancement of image-based brachytherapy to optimize outcomes for cervical cancer patients.     

影像引导宫颈癌三维腔内放疗的临床初步观察

背景与目的：放射治疗是宫颈癌的主要治疗方法。通过分析苏州大学附属第一医院放疗科收治的31例初治宫颈癌患者三维腔内放疗的剂量体积直方图(dose-volume histogram,DVH)剂量分布和临床结果,观察影像引导宫颈癌三维后装放疗患者的近期疗效及放射反应。方法：选取2013年5月—2014年12月在苏州大学附属第一医院放疗科行根治性放疗的31例初治宫颈癌患者,FIGO期为Ⅱa~Ⅳ期。每例患者接受4~6次CT引导下的三维后装放疗,单次高危临床靶区(high risk-clinical target volume,HR-CTV)给予400~600 cGy处方剂量,31例患者共计153次施源器置入,采用¹⁹²Ir高剂量率后装治疗机实施腔内放疗。分析内外照射的HRCTVD90、膀胱D2cc、乙状结肠D2cc、直肠D0.1cc和直肠D2cc,采用EQD2进行剂量计算。按照RTOG/EORTC放射反应评分标准和RECIST 1.1评价标准分析放射反应和近期疗效。结果：膀胱、直肠、乙状结肠均无3级及以上急性或慢性放射反应。2例患者发生后期直肠出血(2级),经止血和灌肠等对症处理后症状改善。放疗后1~3个月完全缓解率(complete remission,CR)为93.55%(29/31),1年局部控制率(local control rate,LCR)为93.55%(29/31),1年无进展生存率(progression-free survival,PFS)为90.32%(28/31)。结论：CT引导的三维腔内放疗联合外照射治疗局部晚期宫颈癌,定位精确,靶区剂量充足,危及器官的受照剂量可见、可控、可信,提高了患者的治疗耐受性,避免了重度放射反应的发生,大大提高了患者治疗后的生活质量,值得推广应用。     

宫颈癌图像引导三维近距离后装治疗中国专家共识

近年来宫颈癌三维近距离治疗(BT)技术在中国得到快速发展。与二维技术相比,宫颈癌图像引导的三维BT技术可以提高局控率、生存率。三维BT要求用体积剂量参数评价治疗靶区及危及器官受量,探索体积剂量参数与局控率、并发症发生率之间关系。BT开始时肿瘤残留体积及形状与局控率有明确相关性,应当结合MRI、超声、妇科检查结果,综合判断残留肿瘤体积。腔内联合组织间插植技术可以改善靶区剂量分布。严格遵守靶区勾画、体积剂量原则以及质控要求。为规范其应用,中华医学会放射治疗学分会近距离治疗学组、中国医师协会放射肿瘤分会妇科肿瘤学组、中国抗癌协会近距离治疗专委会结合中国国情联合制定此专家共识。     

Chinese expert consensus on three-dimensional image guided brachytherapy for cervical cancer

In recent years, image-guided brachytherapy (IGBT) for cervical cancer has been rapidly developed in China. IGBT can improve local control and survival rates in patients with locally advanced cervical cancer compared with the two-dimensional technology. Dose volume histogram parameters for the high risk clinical target volume (HR-CTV), intermediate risk clinical target volume (IR-CTV) and organs at risk should be calculated, reported, and adopted to explore the relationship with local control rate and incidence of complications. The volume and topography of residual tumor at the initiation of IGBT is significantly correlated with local control rate. The residual tumor should be assessed by the combination of MRI, ultrasound images and gynecological examinations. The appropriate implant with intracavitary applicator supplemented with interstitial needles can improve the dose distribution in the target area. Target delineation, dose assessment and quality control should be conducted strictly according to the principles and consensus. To standardize its application, the Chinese expert consensus was jointly formulated by Brachytherapy Group of China Society for Radiation Oncology, the Gynecological Oncology Group of Chinese Association for Therapeutic Radiation Oncologists, and the Brachytherapy Special Committee of Chinese Anti-Cancer Association in light of the national conditions in China.