Brachytherapy For Cervical Cancer Research Articles

Comparison of two inverse planning algorithms for cervical cancer brachytherapy.

PurposeTo compare two inverse planning algorithms, the hybrid inverse planning optimization (HIPO) algorithm and the inverse planning simulated annealing (IPSA) algorithm, for cervical cancer brachytherapy and provide suggestions for their usage.Material and methodsThis study consisted of 24 cervical cancer patients treated with CT image‐based high‐dose‐rate brachytherapy using various combinations of tandem/ovoid applicator and interstitial needles. For fixed catheter configurations, plans were retrospectively optimized with two methods: IPSA and HIPO. The dosimetric parameters with respect to target coverage, localization of high dose volume (LHDV), conformal index (COIN), and sparing of organs at risk (OARs) were evaluated. A plan assessment method which combines a graphical analysis and a scoring index was used to compare the quality of two plans for each case. The characteristics of dwell time distributions of the two plans were also analyzed in detail.ResultsBoth IPSA and HIPO can produce clinically acceptable treatment plans. The rectum D2cc was slightly lower for HIPO as compared to IPSA (P = 0.002). All other dosimetric parameters for targets and OARs were not significantly different between the two algorithms. The generated radar plots and scores intuitively presented the plan properties and enabled to reflect the clinical priorities for the treatment plans. Significant different characteristics were observed between the dwell time distributions generated by IPSA and HIPO.ConclusionsBoth algorithms could generate high‐quality treatment plans, but their performances were slightly different in terms of each specific patient. The clinical decision on the optimal plan for each patient can be made quickly and consistently with the help of the plan assessment method. Besides, the characteristics of dwell time distribution were suggested to be taken into account during plan selection. Compared to IPSA, the dwell time distributions generated by HIPO may be closer to clinical preference.

The impact of modern preoperative high-dose-rate brachytherapy in early-stage cervical cancer

PurposeTo analyze the clinical outcomes and the safety of preoperative high-dose-rate (HDR) image-guided adaptive brachytherapy (IGABT) followed by minimally invasive surgery (MIS) in the multidisciplinary management of early-stage cervical cancer. Methods and materialsMedical records of all consecutive patients with early-stage cervical cancer treated at our institution between 2012 and 2018 with preoperative IGABT in a multidisciplinary approach were reviewed. Treatment schedule was pelvic node dissection, preoperative IGABT followed 6–8 week later by MIS hysterectomy. ResultsSeventy patients with cervical cancer FIGO stages (IB1 18.6%, IB2 75.7% and IIA1 5.7%) were treated by preoperative HDR brachytherapy. With a median follow-up of 37.4 months [95% confidence interval, 32.1-39.7 months] isolated vaginal vault recurrence was not observed, 3 pelvic relapses were reported (4.3%). None of patients received postoperative radiotherapy (EBRT) or radiochemotherapy. The estimated 3-year local and pelvis relapse free survival for the entire population were respectively 98% [95% confidence interval, 89%–100%] and 90% [80%–96%]. The estimated 3-year disease-free survival (DFS) for the entire population was 88% [77–94%]. The 3-year overall survival (OS) rate was 97% [88%–99%]. Microscopic vaginal resection margin (R1) was observed in one patient ([1].4%). Lymph-vascular space invasion (LVSI) was found found in 6 (8.6%) patients. Forty-eight late complications in 36 patients (51.4%) were observed. Five (7.1%) grade 3 vaginal wound dehiscence toxicities were observed. Urinary and gastrointestinal toxicities were grade 1–2. No grade 4–5 complications were observed. ConclusionsPreoperative image-guided adaptive brachytherapy followed by minimally invasive surgery allows high local control, reduces positive surgical margins and rates of lymph-vascular space invasion avoiding adjuvants treatments. Surgical approaches must be discussed with patients including preoperative brachytherapy as a down-staging treatment.

Risk factors and dose-effects for bladder fistula, bleeding and cystitis after radiotherapy with imaged-guided adaptive brachytherapy for cervical cancer: An EMBRACE analysis

PurposeTo identify patient- and treatment-related risk factors for fistula, bleeding, cystitis, pain and difficulty in voiding in locally advanced cervical cancer patients treated with radio(chemo)therapy and image-guided adaptive brachytherapy (IGABT). Material and methodsMorbidity within the EMBRACE-I study was prospectively reported for physician-assessed (CTCAE) fistula, bleeding and cystitis and patient-reported (EORTC) pain and difficulty in voiding. Analysis of risk factors was performed in patients without bladder infiltration. Risk factors were tested with Cox regression for grade (G) ≥ 3 cystitis, for G ≥ 2 fistula, bleeding and cystitis, and for EORTC “very much” and “quite a bit” or worse. ResultsOf 1416 patients enrolled, 1153 and 884 patients without bladder infiltration were evaluable for the analysis of CTCAE and EORTC items, respectively. Median follow-up was 48[3–120] months. Crude incidence rates for G ≥ 2 fistula, bleeding and cystitis were 0.7%, 2.7% and 8.8%, respectively, and 16% and 14% for ”quite a bit” or worse pain and difficulty in voiding, respectively. Baseline urinary morbidity and overweight/obesity were significant risk factors for most endpoints. Bladder D2cm3 correlated with G ≥ 2 fistula, bleeding and cystitis, while ICRU bladder point dose correlated with EORTC pain “quite a bit” or worse. An increase from 75 Gy to 80 Gy in bladder D2cm3 resulted in an increase from 8% to 13% for 4-year actuarial estimate of G ≥ 2 cystitis. ConclusionClinical and treatment-related risk factors for bladder fistula, bleeding and cystitis were identified within a prospective and multi-institutional setting. A dose–effect was established with bladder D2cm3, reinforcing the importance of continued optimization during individualized IGABT planning.

Computed Tomography–Guided Optimization of Needle Insertion for Combined Intracavitary/Interstitial Brachytherapy With Utrecht Applicator in Locally Advanced Cervical Cancer

PurposeThere are no international guidelines for optimal needle insertion during interstitial intracavitary brachytherapy (IS-ICBT) for cervical cancer. We aimed to investigate the clinical feasibility and added value of computed tomography (CT) guidance to optimize needle insertion in IS-ICBT using the Utrecht applicator and to evaluate needle shifts. Methods and MaterialsWe enrolled 24 patients who were treated with interstitial-brachytherapy. Two CT scans each were performed for every patient: (1) after applicator insertion without needles (CTpreneedle) and (2) after needle insertion (CTpostneedle). In addition to magnetic resonance imaging after external-beam radiation therapy, CTpreneedle was used to determine optimal needle locations and insertion lengths based on applicator and organs at risk positioning on the day of treatment; CTpostneedle was used for IS-ICBT planning. The needle-channel axis was used as a reference to determine needle-shift evolution. ResultsA total of 266 interstitial needles were inserted in 76 of 93 BT fractions with high intra- and interpatient variations in the number of inserted needles. Based on CTpreneedle findings, needle insertion was avoided in 9, 4, 2, and 2 patients at the first, second, third, and fourth fractions, respectively. The unloaded needle frequency was 4%. Average needle contribution to total dwell time was 37.2% ± 19.2%. Shifting was observed in 68% of the needles (mean shift 2.0 ± 2.3 mm), mostly in the posterior direction, and in needles with a larger insertion length. Needle reinsertion was not needed in any patient. No complication due to needle insertion was observed, except for minor vaginal bleeding in 1 patient after needle removal. ConclusionsThe adaptive CT-guided IS-ICBT application was feasible and resulted in fewer unloaded needle insertions or complications and more efficient use with higher needle contribution to the treatment. Needle shift was frequent but did not require needle reinsertion with the proposed method.

Doses to Organs at Risk Calculated Using Plato and Oncentra Softwares in Intracavitary Brachytherapy

This is a retrospective study, the organ doses to the bladder and rectum were compared between Nucletron PLATO V14.2.3 (BV) and newer version software Oncentra MasterPlan V4.3 (OMP) treatment planning systems (TPS). The treatment data of 32 intracavitary brachytherapy patients at Hospital Universiti Sains Malaysia from January 2010 to June 2015 were used. These data sets were used for catheter reconstruction for both PLATO and OMP TPS followed by independent verification using Excel. There is no significant difference in mean doses to organs at risk (OARs) that calculated by both TPS (p>0.05). The mean percentage of doses calculated by PLATO TPS for bladder and rectum were 66.58 ± 27.42 % and 46.27 ± 14.47 % respectively. While the mean percentage of doses for bladder and rectum calculated by OMP TPS were 65.68 ± 24.24 % and 46.46 ± 16.66 respectively. The mean percentage difference in doses comparison between independent verification calculation and PLATO TPS was 1.96 ± 6.00% and then became 6.37 ± 5.17% when it was compared with OMP TPS. Overall, the dose calculation differences for both versions of TPS were within the range recommended by Nuclear Regulatory Commission (NRC). The dose calculations of the two treatment planning systems showed good agreement and both could be used in planning intracavitary brachytherapy for cervical cancer. Whereas Excel based independent verification suitable to be implemented as routine dose verification programme prior to treatment delivery.

Results of image guided brachytherapy for stage IB cervical cancer in the RetroEMBRACE study

ObjectiveMultiple treatment options are used in early local-stage cervical cancer, including combinations of surgery with neoadjuvant/adjuvant radiotherapy and chemotherapy. Our aim was to determine the outcome for definitive chemoradiation with image guided brachytherapy (IGBT). MethodsFIGO1994 staging system was used in our study. We included 123 patients with stage IB cervical cancer, treated at 12 centers with external beam radiotherapy (EBRT) ± Chemotherapy and IGBT. Three- and 5-year actuarial local control (LC), pelvic control (PC), overall survival (OS), cancer-specific survival (CSS) and late morbidity (CTCAE v 3.0) were computed. ResultsMedian age was 48 (23–82) years. FIGO1994 stage distribution was: IB1 68% and IB2 32%; 41% of the entire cohort had nodal metastases and 73% squamous-cell carcinoma. MRI-based tumor size was >40 mm in 63%. Median EBRT dose was 45 (40–50) Gy; 84% received chemotherapy. At IGBT, mean CTV-HR D90 was 93 ± 17 Gy (EQD210). D2cc for bladder was 76 ± 14 Gy, rectum 66 ± 11 Gy, sigmoid 66 ± 10 Gy, bowel 67 ± 7 Gy (EQD23). At 43-months median follow-up, 9% of patients had systemic, 6% paraaortic, 3% pelvic-nodal and 2% local failure. Five-year LC was 98%, PC 96%, CSS 90%, OS 83%. Intestinal G3-–4 morbidity was 8%, urinary 7% and vaginal 0%. ConclusionsChemoradiation with IGBT for FIGO1994 stage IB cervical cancer leads to excellent loco-regional control with limited morbidity. In IB node-negative disease, it can be regarded equivalent to surgery in terms of oncologic outcome. In tumors with unfavorable pre-treatment characteristics, chemoradiation is the first choice to avoid combining surgery with adjuvant therapy.

Assessment of an onco-sexology support and follow-up program in cervical or vaginal cancer patients undergoing brachytherapy.

Women's sexual health and wellbeing with cervical or vaginal cancer may be largely affected by complications from external beam radiotherapy (EBRT) and utero-vaginal brachytherapy (BT), of which vaginal stenosis is the main complication. The objective of this study was to assess the impact of support by a nurse sexologist on sexuality, vaginal side-effects, and the quality of clinical follow-up in patients treated with brachytherapy for cervical or vaginal cancer. We performed a retrospective study of the sexuality of women treated for cervical or vaginal cancer. Data from patients with cervical or vaginal cancer who underwent brachytherapy between 2013 and 2017 were collected at Institut Universitaire de Cancer de Toulouse-Oncopôle (IUCT-Oncopôle). Patients were divided into two groups: group A (intervention group) received support from a nurse sexologist and group B (control group) did not. The chi-square test and a logistic multivariate model were used for data analysis. A total of 156 patients were included in this study, including 57.7% who were followed by a nurse sexologist. We observed low compliance in using vaginal dilators after brachytherapy and/or radiotherapy over time regardless of the group, and patients' sexual activity was inadequately addressed. Information regarding the resumption of sexuality 2 months after treatment was missing in 1.1% of patients in group A and in 36.4% of patients in group B. Multivariate analysis showed that patients in group A had a lower risk of developing vaginal stenosis with OR crude = 0.5 (95% CI = 0.25-0.92) and OR adj. = 0.5 (95% CI = 0.26-1.09) compared with those in group B. This retrospective study highlights the lack of information collected by physicians during follow-up concerning the sexuality of patients with cervical or vaginal cancer treated by EBRT and BT. The support offered by nurse sexologists in improving patients' sexual activity and reducing their physical side-effects such as vaginal stenosis is likely to be beneficial. A prospective study is currently being conducted to validate the present findings.

HDR brachytherapy using cylinder, tandem-ovoid (T&O) and interstitial implant with prognosis

Purpose: Among the therapeutic modalities available for the treatment of cervical cancer, irradiation is regarded to be the standerd treatment for all tumor stages, which includes external beam radiation therapy and HDR brachytherapy or a combination of these two. This modality of cancer, needless to say, is prevalent in Bangladesh as the women are coming forward for its detection. Dramatic advances have been made in brachytherapy for cervical cancer. Radiation treatment planning has evolved from two-dimensional to three-dimensional, incorporating magnetic resonance imaging and/or computed tomography into the treatment paradigm. This allows for better delineation and coverage of the tumor, as well as improved avoidance of surrounding organs. Brachytherapy applications are not restricted to one method only; any method could be combined with another, as well as other radiotherapy techniques. In cervical cancer, intracavitary brachytherapy (ICBT) has been used for practical reasons. Lately though, combination of ICBT and interstitial brachytherapy (ISBT) techniques are being evaluated in deference to feasibility, practicality and reproducibility. Advanced brachytherapy can achieve very high rates of local control with a reduction in morbidity, compared with historic approaches. This study provides an overview of state-of-the-art gynecologic brachytherapy, with a focus on recent advances and their implications for women with cervical cancer.Materials and Methods: Three patients were selected on different staging. Three different types of applicator (Cylinder, Tandem and Ovoid and Interstitial Implant) were inserted according to the patient’s anatomy and staging. Prescribed dose were different for the implant technique.Result: Progress from 2D- to 3D-based imaging and treatment planning for cervical cancer brachytherapy has improved local control, reduced toxicity, and improved overall survival for women.Conclusion: The result of our study indicates that a precise delivery of treatment by applying a appropriate applicator and the choice of treatment planning technique is more important for a better outcome.

Comparison of the Dosimetric Influence of Applicator Displacement on 2D and 3D Brachytherapy for Cervical Cancer Treatment

To compare the dosimetric influence of applicator displacement on two-dimensional brachytherapy (2D-BT) and three-dimensional brachytherapy (3D-BT) for cervical cancer. Nineteen patients who received computed tomography-guided tandem-and-ovoid (T&O) brachytherapy were retrospectively selected. Both 2D (point-based) and 3D (volume-based) plans with and without virtual applicator displacement in the 3 axes were created for each patient. Dose changes at point A, D90 of the high-risk clinical target volume (HR-CTV) and intermediate-risk CTV (IR-CTV), and the D0.1cc, D1cc, D2cc, and D5cc of organs-at-risk (OARs) caused by applicator displacement were evaluated. Both 2D-BT and 3D-BT plans were sensitive to T&O applicator displacement. The D90 of the CTV and the dose at point A were very sensitive to applicator displacement in the right–left direction (X-axis). An applicator shift of >2 mm in the X-axis resulted in a change of >5% in the dose at point A and D90 of HR-CTV and IR-CTV. In addition, the doses to the OARs were mostly affected by applicator displacement in the anterior–posterior direction (Z-axis). A displacement of <1.5 mm in the Z-axis was required to avoid a dose change of >10% for OARs. For both 2D-BT and 3D-BT plans, T&O displacement greater than ± 2 mm in the X-axis or T&O applicator displacement ± 1.5 mm in the Z-axis resulted in significant dose changes to the tumor and OARs. In comparison with 3D-BT plans, 2D-BT plans delivered a higher dose to the tumor, and the OARs received more undesirable doses when applicator displacement occurred. The influence of applicator displacement on the doses to the tumor and OARs differed between 2D-BT and 3D-BT. Physicians should take individual patient differences into account when selecting a brachytherapy plan to mitigate the influence of applicator displacement.

Brachytherapy utilization for cervical cancer in Western United States border counties: seeking to understand referral patterns for outcome improvement.

PurposeStandard of care for definitive treatment of locally advanced cervical cancer (LACC) is concurrent chemoradiation followed by a brachytherapy boost. Only 55.8% of women in the United States receive brachytherapy, with even lower proportions in San Diego and Imperial Counties. The purpose of this study was to investigate brachytherapy practice and referral patterns in Western United States border region.Material and methodsA short survey was sent to 28 radiation oncologists in San Diego and Imperial Counties, who treat patients with gynecologic malignancies. Descriptive statistics were used for analysis.ResultsSeventeen (61%) physicians responded to the survey. All physicians reported some training in cervical cancer brachytherapy during residency, with median 6 months. Only two physicians reported personally treating all cervical cancer patients with brachytherapy; however, 92% of remaining physicians would recommend brachytherapy for patients if given time and access. The most common reason for referral (78%) was patients deemed to require hybrid or interstitial brachytherapy implants. Barriers to referral included patients’ preference, insurance status, their resources, or logistics. No changes were reported for brachytherapy practices during the COVID-19 pandemic, except the addition of pre-procedural testing for SARS-CoV-2. Ninety-two percent of physicians identified inadequate maintenance of skills as a barrier to performing brachytherapy, but 77% were not interested in additional training. External beam radiation therapy boosts were rarely recommended in case scenarios describing potentially curable patients.ConclusionsThe importance of brachytherapy is widely recognized for conferring a survival benefit, but barriers to implementation include inadequate training or maintenance of skills, and larger systematic issues related to reimbursement policy, social support, and financial hardship. As most established providers were uninterested in additional brachytherapy training, future approaches to improve patients’ access should be multidimensional and reflect the value of brachytherapy in definitive treatment of patients with LACC.

Quantitative and qualitative application of clinical drawings for image-guided brachytherapy in cervical cancer patients.

PurposeClinical drawings are integral part of image-guided adaptive brachytherapy (IGABT) of cervical cancer. It was used in EMBRACE study protocol as a useful tool. In our study clinical drawings from EMBRACE study were modified to include scales in all the dimensions for more accurate representation of various tumor related volumes. The aim of the present study was to understand patterns of tumor regression and relationship between gross tumor at diagnosis (GTVD) and high-risk clinical target volume (CTV-THR)/intermediate-risk clinical target volume (CTV-TIR) in brachytherapy (BRT), using modified clinical drawings.Material and methods42 cervical cancer patients, staged as FIGO IIB-IIIB according to EMBRACE study, were enrolled. Advanced schematic 3D mapping diagram (3D-MD) in axial, coronal, and sagittal orientations, with a measurement scale (grid with 10 mm distance) for precise assessment and documentation was applied (through MRI at diagnosis and during brachytherapy). Dimensions, including height, width, and thickness as well as volumes (GTVD, CTV-THR and CTV-TIR) were compared both qualitatively and quantitatively.Results and conclusionsWe found qualitative and quantitative correlation of the dimensions of final CTV-THR with initial GTVD. Meticulous mapping of tumor volumes can provide useful insights to CTV-THR volume during brachytherapy.

Prevention of uterine perforation during intracavitary brachytherapy of cervical cancer

PurposeIntracavitary brachytherapy (ICBT) is a part of standard treatment for loco-regionally advanced cervical cancers. ICBT requires a tandem applicator insertion through cervical canal into uterine cavity. Accurate placement through cervical canal, which is distorted by cancer, is crucial to successful treatment. The objective of this study was to investigate actual complication rate of a Smit sleeve insertion performed by experienced gynecologists in a tertiary referral center.Material and methodsClinical data of 328 patients with cervical cancer treated using ICBT, between January 2013 and August 2019, were retrospectively evaluated. Predisposing factors that could have increased the risk of uterine perforation were recorded. Pre-operative ultrasound was carried out for visualization of uterine curvature and selection of an appropriate Smith sleeve length. All applications were performed by a gynecologic oncology fellow or an expert gynecologist.Results317 patients were suitable for analysis. Only one (0.3%) applicator placement resulted in uterine perforation. In two patients, Smit sleeve dislocated after first brachytherapy and reinserted. Adequate applicator placement was achieved, and treatment was completed as planned in 316 cases.ConclusionsA cervical sleeve technic, which reduced the need for multiple insertions and placement of this instrument by an expert gynecologist minimize the risk of complication relative to historical controls.

Intraoperative ultrasound guidance during intra-cavitary brachytherapy of cervical cancer

Intraoperative ultrasound guidance during intra-cavitary brachytherapy of cervical cancer

Reproducibility of vaginal immobilization balloons in situ overnight for cervical cancer brachytherapy.

PurposeThe use of vaginal immobilization balloons placed into the vagina for immobilization of tandem and ovoid (T+O) applicator during high-dose-rate (HDR) brachytherapy delivery has been used at our institution, and seems to have improved our patient comfort, decreased procedure time, and minimized applicator misplacement. We aimed to show that these balloons, while originally marketed for single-day use, are safe and maintain applicator positioning/dosimetry when left in situ overnight for treatment delivery on sequential days.Material and methodsForty-two paired computed tomography (CT) scans from thirteen patients who underwent T+O HDR treatments on sequential days with vaginal immobilization balloons in situ overnight were retrospectively compared to calculate mean change of balloon volumes and balloon/T+O distance to bony landmarks. Dosimetric planning was retroactively performed on day 2 using CT scan of each pair, and the change in estimated radiation delivery to the bladder and rectum was compared.ResultsNo statistically significant overnight changes were found in balloon volumes or anterior balloon positioning. The posterior balloon shifted –0.29 ±0.46 cm (p = 0.03) to the anterior public symphysis and 0.32 ±0.50 cm (p = 0.01) to the right femoral head. The tandem shifted 0.37 ±0.39 cm (p = 0.002) to the pubic symphysis. There was no significant difference found in radiation delivered to the bladder or rectum between the paired scans.ConclusionsThis study showed minimal change in balloon volumes, balloons/T+O positioning, or in radiation dose to bladder and rectum when the applicator remained overnight. These findings support that inflatable vaginal immobilization balloons remaining in situ overnight for additional HDR T+O treatments on sequential days, is safe and provides stable dosimetry.

Brachytherapy-based radiotherapy is associated with improved survival for newly diagnosed metastatic cervical cancer

PurposeThe purpose of this study was to explore the value of brachytherapy (BT) in metastatic cervical cancer, as it has not been well evaluated before. Methods and materialsWe analyzed 2391 patients with Stage IVB cervical cancer from 2004 to 2015 by using data from the Surveillance, Epidemiology, and End Results registry. The parameters were analyzed by Kaplan–Meier and Cox proportional hazards regression models to evaluate cancer-specific survival (CSS) and overall survival. ResultsIn general, both univariate and multivariate analysis showed that age, histologic type, tumor size, and chemotherapy were associated with CSS and overall survival (p < 0.05). Further subgroup analysis showed BT alone or BT combined with external beam radiotherapy improved CSS despite the tumor size. In addition, chemotherapy and chemoradiotherapy prolonged CSS compared with external beam radiotherapy alone or no chemotherapy or radiotherapy independently of tumor size (p < 0.05). ConclusionsFor newly diagnosed metastatic cervical cancers, BT with or without external beam radiotherapy is associated with improved survival. As an aggressive option, chemoradiotherapy is also a potential treatment strategy.

PO-1132: Magnetic resonance imaging (mri) based image-guided adaptive brachytherapy in cervical cancer.

PO-1132: Magnetic resonance imaging (mri) based image-guided adaptive brachytherapy in cervical cancer.

PD-0659: Looking Beyond D90: Correlating EUBED, gBEUD with Outcome in Cervical Cancer Brachytherapy

PD-0659: Looking Beyond D90: Correlating EUBED, gBEUD with Outcome in Cervical Cancer Brachytherapy

OC-1047: Dose to vaginal wall in cervical cancer brachytherapy and associated morbidity

OC-1047: Dose to vaginal wall in cervical cancer brachytherapy and associated morbidity

PO-1117: Two-step adaptive 3-D conformal brachytherapy for advanced bulky cervical cancer

PO-1117: Two-step adaptive 3-D conformal brachytherapy for advanced bulky cervical cancer

Simulation-based graduate medical education in MR-guided brachytherapy for cervical cancer

PurposeBrachytherapy is critical for the curative treatment of locally advanced cervical cancer. Although brachytherapy use is declining in the United States (U.S.), novel interstitial or intracavitary applicators and advances in image guidance for applicator placement and treatment planning have allowed for tumor dose escalation while reducing normal tissue toxicity. Recent survey data have suggested insufficient brachytherapy training for radiation oncology trainees in the United States. This study aimed to address these gaps by developing and piloting a simulation-based education (SBE) workshop for MR-guided cervical cancer brachytherapy. Methods and MaterialsAn SBE workshop was developed for graduate medical education (GME) trainees focusing on MR-guided brachytherapy for cervical cancer. Four hands-on stations, simulating aspects of the procedure, were led by a team of gynecological brachytherapy experts. The learners were radiation oncology residents and fellows in a U.S. GME training program. The primary outcome was feasibility, assessed by completion of the workshop within the time constraints of the curriculum. Learners completed preworkshop and postworkshop surveys to provide information on efficacy. ResultsThe workshop was successfully completed in a 1-h block of GME didactic time. Ten trainees completed all four stations, and all completed preworkshop and postworkshop surveys, which showed improvements in knowledge and technical proficiency. Feedback was positive, and trainees requested additional learning opportunities. ConclusionsThis study showed that GME-focused SBE in MR-guided cervical cancer brachytherapy was feasible. SBE provided a nonclinical environment in which to practice aspects of MR-guided brachytherapy. Ongoing work includes collaboration with other U.S. institutions. Future studies should focus on international adaptation.