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The Riga East Hospital has introduced a new brachytherapy method for targeted and effective irradiation of cancer cells, offering the gentlest possible treatment
The Riga East Hospital has introduced a new brachytherapy method for targeted and effective irradiation of cancer cells, offering the gentlest possible treatment
For the first time in Latvia, Riga East University Hospital (Riga East Hospital) has successfully applied a new and effective method of intracavitary radiotherapy, or brachytherapy, for cervical cancer patients. This method significantly reduces radiation complications and is more gentle compared to traditional radiation methods.
Brachytherapy is an important part of treatment, enabling higher doses of radiation to be delivered directly to the tumour site, significantly reducing radiation’s impact on adjacent organs. This approach improves tumour local control and reduces both acute and late complications from treatment.
Margit Valgma, an experienced radiation oncologist from the North Estonian Regional Hospital in Tallinn, Estonia, came to the first brachytherapy procedure in Latvia to share her experience and follow the stages of tumour irradiation. On the 11th of July 2024, a multidisciplinary team at the Riga East Hospital performed the first brachytherapy procedure in Latvia using the new method. The team included two new radiation oncologists Zane Ruduša and Māra Vilka, along with anaesthesiologists, radiographers, radiation therapists, medical physicists, operating room nurses, patient care nurses, and support staff.
“The introduction of this radiation procedure for cervical cancer patients was possible due enthusiasm of our young doctors — their desire to learn the latest invasive manipulation techniques, preceded by internships at leading clinics in Europe and around the world. Equally important is the availability of advanced medical equipment and technologies, which enable us to treat cancer patients as gently as possible. And finally, the introduction of new treatment methods is impossible without multidisciplinary cooperation between doctors of different specialities and support staff, which is only possible in a university-level hospital,” says Arturs Šorubalko, head of the Therapeutic Radiology and Medical Physics Clinic at the Riga East Hospital.
How the First Brachytherapy Treatment Went
The patient had previously undergone a course of external beam radiation therapy and concomitant chemotherapy for her cervical cancer. During the procedure, applicators were inserted into the uterus while the patient was under intravenous anaesthesia in the operating room; and then interstitial needles were placed in the cervix and tumour tissue. After this procedure and waking up the patient was taken for imaging. The patient underwent both MRI and CT scans, as these examinations are necessary to visualise the tumour in order to target the area where the radiation dose needs to be delivered. After the imaging examinations, the patient was taken to the radiotherapy ward to rest and after some time the second part of the procedure could start.
A radiotherapy plan was created to deliver radiation dose to the tumour. Both the radiation oncologists and medical physicists were involved in this step. Once the plan was finished and approved, radiation was administered through the applicators placed in the patient. This final stage of the procedure lasted approximately 10 to 20 minutes.
After the procedure, the patient was transferred to the inpatient ward to await a second radiation session scheduled for the following morning, where the patient underwent a repeated CT scan to confirm that the applicators had remained in position during the night. Since the applicators had not moved, a second dose of radiation could be administered. After the procedure was completed, the applicators were removed. The patient was transferred to the radiotherapy ward where her condition was monitored.
One week later, the patient will undergo the procedure again: brachytherapy applicators with interstitial needles will be inserted, imaging will be performed, a radiotherapy plan will be developed, and two doses of radiation will be administered once more. After completing this course of brachytherapy, the patient will have finished her course of treatment. She will be followed up by a radiation oncologist, a gynaecologic oncologist, and a general practitioner.
“According to European and American guidelines, MRI-guided radiotherapy and brachytherapy are considered the gold standard for treating cervical cancer patients.” Brachytherapy is an important part of treatment, enabling higher doses of radiation to be delivered directly to the tumour tissue, significantly minimising the adverse effects on adjacent healthy organs. “This improves local control of the malignancy and reduces both acute and late complications of the therapy,” explains Zanda Liepa, head of the Radiotherapy Clinical Unit.
“Until now, standard applicators have been used for brachytherapy procedures in Latvia, which are inserted through the vagina into the uterus and near the cervix. Today, to enhance the accuracy and effectiveness of the procedure, special interstitial needles are added to the standard applicators and inserted directly into the tumour tissue. The addition of needles is particularly beneficial when the tumour is large or growing asymmetrically,” says Zane Ruduša, radiation oncologist.
“Following guidelines and using interstitial needles, the overall survival rates are 88% for stages I and II, and 71% for stages III and IVA. MRI-guided brachytherapy ensures a 10% improvement in overall survival. Combined interstitial brachytherapy reduces chronic toxicity by 3% to 6% for each organ at risk (bladder, rectum, sigmoid, small bowel, vaginal mucosa),” says Māra Vilka, radiation oncologist, highlighting the benefits of the new brachytherapy method.
The choice of cervical cancer treatment primarily depends on the stage of the tumour at the time of diagnosis. Surgical treatment is the treatment of choice for early-stage tumours where radical surgery is possible. These tumours are located within the cervix and have not spread to the lymph nodes or other distant organs. For larger tumours that cannot be treated with radical surgery, the recommended approach is a combination of radiotherapy and chemotherapy. Combined radiotherapy consists of external beam radiotherapy and brachytherapy. Approximately 70% of all cervical cancer patients will receive combined chemoradiation.
Cervical cancer is one of the most common cancers among women worldwide, and active efforts are made to improve treatment outcomes and overall survival. Cervical cancer is also the second most common cancer among women of working age.
In Latvia, according to the World Health Organization, the incidence of cervical cancer was 26.3 cases per 100,000 inhabitants in 2021. The five-year overall survival rate for cervical cancer patients in EU countries is 62% on average, with the lowest rates in Latvia and Bulgaria at 51%.
Oncology Centre of Latvia of the Riga East Hospital is the only hospital in Latvia offering brachytherapy to patients. On average, 150 patients with cervical cancer receive radiotherapy, including brachytherapy, at the Therapeutic Radiology and Medical Physics Clinic each year.
The new brachytherapy procedure was carried out with the involvement of the following personnel:
- Margit Valgma, radiation oncologist at Tallinn North Estonia Regional Hospital
- Lidija Buklovska, Head of the Department 7b of Radiotherapy Clinical Unit at the Clinic of Therapeutic Radiology and Medical Physics, and Māra Vilka and Zane Ruduša, young radiation oncologists
- Marika Čakare, Indra Surkova, Džeina Platace, medical physicists, and Nikolai Saveljev, a medical physicist from Estonia
- Jolanta Neliuss, Evita Bladiko, radiation therapist
- Krista Staģīte, radiographer
- Aigars Seņkāns, Chief Oncology Physician, Department of Anaesthesiology and Intensive Care, Oncology Centre of Latvia
- Jūlija Grigorjeva, anaesthesiologist
- Irina Aleksejenoka, anaesthesiology nurse
- Ina Budņikova, surgical chief nurse; Vilma Tjarvja, surgical nurse; Anda Žeibe, nurse; Jeļena Docenko, assistant nurse
- Dace Markovska, orderly
- The following personnel helped prepare for new brachytherapy treatment:
- Arturs Šorubalko, head of the Therapeutic Radiology and Medical Physics Clinic
- Zanda Liepa, head of the Radiotherapy Clinical Department
- Romāns Bukbārdis, head of the Department of Radiology at the Oncology Centre of Latvia.
Images to illustrate the new brachytherapy treatment: https://www.flickr.com/photos/austrumu_slimnicas_foto/albums/72177720318897026
