Shirley Lewis

Feasibility Study of Using Kv-Cone Beam CT Images as Patient Specific Quality Assurance Tool

Patient-specific quality assurance (PSQA) typically involves the comparison between the planned fluence and the delivered fluence of a routine CT (Computed Tomography)-based radiotherapy plan. In contrast the study focuses on evaluating the kV-CBCT (Kilovoltage Cone beam Computed Tomography) image set as a potential tool for assessing the delivered dose for  images of same cervical cancer patient, enabling the daily assessment and verification of planned dose distributions. This research comprised 13 cervical cancer patients who received treatment at the Department of Radiation therapy and Oncology, Kasturba Hospital, Manipal, between 2023 and 2024. Monaco software-5.11.03 was used for image registration, segmentation and treatment planning. Planned fluence verification was analysed using the PTW MEPHYSTO software, a fluence comparison tool. Minor, statistically insignificant differences were observed in dose distribution between kVCBCT and routine CT image-based plans. The planned fluence on kVCBCT images met gamma criteria for most cases, with occasional deviations in specific anatomical planes. This study sums up that the dose distribution and planned fluence on kVCBCT images effectively correlated with planning CT images, thereby supporting the daily verification and assessment of planned dose distributions using kVCBCT images for cervical cancer cases.

Diagnostic and prognostic significance of circulating HPV cfDNA in cervical cancer: A systematic review and meta-analysis

Human papillomavirus circulating free DNA (HPV cfDNA) is an emerging biomarker with potential utility in the detection and treatment monitoring of cervical cancer. To conduct a systematic review and meta-analysis evaluating the diagnostic and prognostic performance of HPV cfDNA in cervical cancer. A comprehensive literature search was conducted in PubMed, CINAHL, Cochrane Library, Scopus, and Embase through April 2025. Eligible studies reported or allowed calculation of diagnostic performance of HPV cfDNA in HPV-positive cervical cancer patients and/or included serial HPV cfDNA testing during post-treatment follow-up. Meta-analyses were conducted using a random-effects model. Heterogeneity was assessed with the I² statistic. The review followed PRISMA guidelines, and study quality was assessed using QUADAS-2. Of 106 studies screened, 20 met the inclusion criteria. Eleven studies contributed to the diagnostic meta-analysis and six to the prognostic analysis. The pooled sensitivity and specificity of HPV cfDNA for cervical cancer detection were 0.47 (95 % CI, 0.43-0.52) and 0.96 (95 % CI, 0.92-0.98), respectively. Positive and negative likelihood ratios were 10.49 and 0.28, with a diagnostic odds ratio of 71.31. The area under the SROC curve was 0.9825, indicating excellent overall diagnostic performance. Prognostically, HPV cfDNA positivity at 3 months post-treatment was significantly associated with reduced progression-free survival (HR = 8.50; 95 % CI, 4.69-15.41; I² = 0 %). HPV cfDNA shows high specificity and strong prognostic value, supporting its clinical utility in cervical cancer detection and treatment surveillance.

Reirradiation with advanced brachytherapy techniques in recurrent GYN cancers

To evaluate clinical outcomes of recurrent gynaecological cancers treated with reirradiation (reRT) using advanced brachytherapy (BT) technique. Seventy-six women who underwent reRT with BT for gynaecological cancers at our institute between January 2000 and December 2019 were analysed to determine patient, disease and treatment characteristics and clinical outcomes. Descriptive analysis was used for demographics, and the Kaplan Meir method was used for survival analysis. Median age at recurrence was 55 years (Range: 35-73). Forty-three patients had recurrent cervical cancer with intact uterus, and 33 had recurrent vault/vaginal cancers post adjuvant RT. Eight patients received EBRT prior to BT (Range: 30-50Gy). Twenty-two patients (28.9%) received salvage chemotherapy before consideration of brachytherapy. Brachytherapy application was done using MUPIT in 38, Vienna applicator in 20, Syed Neblett in 8, central vaginal cylinder in 3, multicatheter intravaginal applicator in 2, tandem-ovoids in 4 and Houdek applicator in 1 patient. Median cumulative EQD2 for all courses of radiation was 108 Gy (IQR 92-123 Gy). At median follow up of 39 months, local control (LC), progression-free survival (PFS) and Overall survival (OS) at 2-years was 60%, 56.3%, and 72.9 respectively. Patients who had recurrences beyond 2 years had significantly better OS compared to early recurrences. Patients who received BT doses >40 Gy had a higher LC and PFS. Grade 3 to 4 late rectal toxicity was seen in 10 (13%), bladder toxicity in 6 (8%) and vaginal fibrosis in 24 (31%) patients. The use of advanced BT approach in reirradiation setting is a feasible and safe option in treatment of post-treatment recurrent cervical, endometrial, and vaginal cancers.