Clinical Workflow of High Dose Rate Brachytherapy for Gynecologic Cancer Patients at the Siriraj Brachytherapy Center (SiBTC), Siriraj Hospital

Abstract

This article presents an overview of the clinical workflow for High Dose Rate Brachytherapy (HDR-BT) in gynecologic cancer at the Siriraj Brachytherapy Center, Siriraj Hospital. As HDR-BT plays a fundamental role in managing locally advanced cervical cancer, the standard treatment process at the center strictly comprises five essential stages: patient preparation, applicator insertion, image acquisition (via computed tomography or magnetic resonance imaging), treatment planning, and radiation delivery. These procedures are executed using a remote afterloader system in conjunction with a sophisticated three-dimensional (3D) treatment planning system. Managed by a multidisciplinary team of radiation oncologists, medical physicists, radiation therapists, and nurses, the workflow ensures high precision and patient safety throughout the entire process. While most treatment-related side effects remain mild and self-limiting, the center emphasizes patient education and regular follow-up to minimize long-term complications. Recent technological advancements, specifically the integration of image-guided brachytherapy (IGBT) and the implementation of 3D-printed applicators, have further significantly improved treatment accuracy and clinical outcomes. These developments enhance the quality of gynecologic cancer care at the Siriraj Brachytherapy Center, ensuring its alignment with international standards of modern brachytherapy practice. This procedure employs the Varian Bravos™ afterloader alongside the BrachyVision 3D treatment planning software, executed by a multidisciplinary team comprising Radiation Oncologists, Medical Physicists, Radiation Therapist, and Nursing Staff to ensure a high degree of precision and safety throughout the process. The majority of side effects associated with this treatment are mild and typically resolve without intervention. Furthermore, effective patient education and routine follow-up care are essential in minimizing the risk of long-term complications. Recent advancements, including the adaptation of image-guided HDR-BT techniques and the integration of 3D-printed applicators, have significantly enhanced treatment precision, safety, and clinical outcomes, thereby elevating the standard of gynecologic cancer care to meet international standards.