Pub Date : 2025-07-10DOI: 10.1016/j.brachy.2025.05.007
Linda Rossi , Rik Bijman , Supriya Chopra , Prachi Mittal , Subhajit Panda , Henrike Westerveld , Miranda Christianen , Inger-Karine Kolkman-Deurloo , Sebastiaan Breedveld , Remi Nout , Ben Heijmen
BACKGROUND AND PURPOSE
A rule-based AI system for automated adaptive treatment planning for image guided adaptive brachytherapy (IGABT) of locally advanced cervical cancer (LACC) was developed at Erasmus MC, and internally and externally validated by Erasmus MC and Tata Memorial Centre (TMC), respectively.
MATERIALS AND METHODS
The BiCycle system generates automated plans with adapted requirements for each fraction, considering previously delivered external beam radiotherapy (EBRT) and BT doses, according EMBRACE-II protocol. It optimizes dosimetric parameters and loading patterns for available radioactive source positions. The system’s effectiveness was validated by comparing automatically generated plans (AUTO) with manually generated, clinically delivered plans (MANUAL) of (1) dosimetry parameters and loading pattern visual inspection of 15 previously treated patients, for internal validation and (2) dosimetry and qualitative comparison by two TMC physicians of 20 previously treated patients, for external validation.
RESULTS
With comparable target doses, AUTO plans had reduced D2cm3 (expressed as EBRT + BT total EQD2α/β) for bladder, rectum, sigmoid and bowel compared to MANUAL plans with average gains of 5.3 Gy, 2.4 Gy, 2.5 Gy and 2.7 Gy, respectively, for internal validation, and of 3.6 Gy, 4.3 Gy, 1.9 Gy and 1.1 Gy, respectively, for external validation. The two TMC physicians preferred the AUTO plans in 76.3% and 75.0% of comparisons.
CONCLUSION
A novel AI-system for fully automated IGABT treatment planning for LACC allowed high-quality plan optimization in on average 1.6 min. AUTO plans were considered superior in quality compared to MANUAL plans in both internal and external validations, even without optimizing the system’s configuration for the external center.
{"title":"Rule-based AI automated adaptive treatment planning for image guided cervical cancer brachytherapy","authors":"Linda Rossi , Rik Bijman , Supriya Chopra , Prachi Mittal , Subhajit Panda , Henrike Westerveld , Miranda Christianen , Inger-Karine Kolkman-Deurloo , Sebastiaan Breedveld , Remi Nout , Ben Heijmen","doi":"10.1016/j.brachy.2025.05.007","DOIUrl":"10.1016/j.brachy.2025.05.007","url":null,"abstract":"<div><h3>BACKGROUND AND PURPOSE</h3><div>A rule-based AI system for automated adaptive treatment planning for image guided adaptive brachytherapy (IGABT) of locally advanced cervical cancer (LACC) was developed at Erasmus MC, and internally and externally validated by Erasmus MC and Tata Memorial Centre (TMC), respectively.</div></div><div><h3>MATERIALS AND METHODS</h3><div>The <em>BiCycle</em> system generates automated plans with adapted requirements for each fraction, considering previously delivered external beam radiotherapy (EBRT) and BT doses, according EMBRACE-II protocol. It optimizes dosimetric parameters and loading patterns for available radioactive source positions. The system’s effectiveness was validated by comparing automatically generated plans (AUTO) with manually generated, clinically delivered plans (MANUAL) of (1) dosimetry parameters and loading pattern visual inspection of 15 previously treated patients, for internal validation and (2) dosimetry and qualitative comparison by two TMC physicians of 20 previously treated patients, for external validation.</div></div><div><h3>RESULTS</h3><div>With comparable target doses, AUTO plans had reduced D<sub>2cm<sup>3</sup></sub> (expressed as EBRT + BT total EQD2<sub>α/β</sub>) for bladder, rectum, sigmoid and bowel compared to MANUAL plans with average gains of 5.3 Gy, 2.4 Gy, 2.5 Gy and 2.7 Gy, respectively, for internal validation, and of 3.6 Gy, 4.3 Gy, 1.9 Gy and 1.1 Gy, respectively, for external validation. The two TMC physicians preferred the AUTO plans in 76.3% and 75.0% of comparisons.</div></div><div><h3>CONCLUSION</h3><div>A novel AI-system for fully automated IGABT treatment planning for LACC allowed high-quality plan optimization in on average 1.6 min. AUTO plans were considered superior in quality compared to MANUAL plans in both internal and external validations, even without optimizing the system’s configuration for the external center.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 5","pages":"Pages 711-720"},"PeriodicalIF":1.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-02DOI: 10.1016/j.brachy.2025.05.006
Mira Keyes , Alina Emiliana Sturdza , Juanita Crook , Bethany Anderson , Luca Boldrini , Junzo Chino , Stefanie Corradini , Christopher Deufel , Andrew Farach , Michael R. Folkert , Steven J. Frank , Jean-Michel Hannoun-Levi , Peter Hoskin , Ina Jurgenliemk-Schulz , Mitchell Kamrava , Marisa Kollmeier , Mahta Mirzaei McKee , Peter Orio F. III , Peter Rossi , Bradley R. Pieters , Gerard Morton
Brachytherapy is an essential skill in the practice of radiation oncology and is an important component of high-quality, full-service radiation oncology departments. With rapidly changing technology, the role of brachytherapy is constantly evolving, but it remains critically important for optimal patient care in several disease sites. As a procedural aspect of radiation oncology practice, brachytherapy requires a fundamentally different and more focused training approach, with specific training objectives, a unique knowledge base, and specialized training environment. The existing gap in brachytherapy training and experience is compounded with a lack of standardized training objectives. Consensus statement objectives were in part adapted with permission from the Royal College of Physician and Surgeons of Canada, and then further reviewed, modified and enriched with expert knowledge by all authors. Training objectives were further synchronized with the US Accreditation Council for Graduate Medical Education (ACGME).
This ABS/GEC-ESTRO Consensus Statement of training objectives will facilitate brachytherapy training by outlining the necessary knowledge and procedural skills for successful practice in brachytherapy. The final brachytherapy curriculum development for any individual program, country and regions, is the responsibility of the individual programs and licensing jurisdictions and should be tailored to their patient population, available equipment and facilities.
{"title":"Joint ABS/GEC-ESTRO Consensus Statement on the objectives of training in brachytherapy for physicians","authors":"Mira Keyes , Alina Emiliana Sturdza , Juanita Crook , Bethany Anderson , Luca Boldrini , Junzo Chino , Stefanie Corradini , Christopher Deufel , Andrew Farach , Michael R. Folkert , Steven J. Frank , Jean-Michel Hannoun-Levi , Peter Hoskin , Ina Jurgenliemk-Schulz , Mitchell Kamrava , Marisa Kollmeier , Mahta Mirzaei McKee , Peter Orio F. III , Peter Rossi , Bradley R. Pieters , Gerard Morton","doi":"10.1016/j.brachy.2025.05.006","DOIUrl":"10.1016/j.brachy.2025.05.006","url":null,"abstract":"<div><div><span>Brachytherapy is an essential skill in the practice of </span>radiation oncology and is an important component of high-quality, full-service radiation oncology departments. With rapidly changing technology, the role of brachytherapy is constantly evolving, but it remains critically important for optimal patient care in several disease sites. As a procedural aspect of radiation oncology practice, brachytherapy requires a fundamentally different and more focused training approach, with specific training objectives, a unique knowledge base, and specialized training environment. The existing gap in brachytherapy training and experience is compounded with a lack of standardized training objectives. Consensus statement objectives were in part adapted with permission from the Royal College of Physician and Surgeons of Canada, and then further reviewed, modified and enriched with expert knowledge by all authors. Training objectives were further synchronized with the US Accreditation Council for Graduate Medical Education (ACGME).</div><div>This ABS/GEC-ESTRO Consensus Statement of training objectives will facilitate brachytherapy training by outlining the necessary knowledge and procedural skills for successful practice in brachytherapy. The final brachytherapy curriculum development for any individual program, country and regions, is the responsibility of the individual programs and licensing jurisdictions and should be tailored to their patient population, available equipment and facilities.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 5","pages":"Pages 631-643"},"PeriodicalIF":1.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-02DOI: 10.1016/j.brachy.2025.04.008
Stephanie Gulstene , Razan Amjad , Lucas C. Mendez
BACKGROUND
Paracervical block is a technique to provide local anesthesia with evidence supporting its use for various gynecologic procedures; however, the literature on its use for gynecologic brachytherapy is limited. This systematic review seeks to understand the efficacy and safety of paracervical block in cervical cancer brachytherapy.
METHODS
PubMed and EMBASE/Cochrane Library databases were searched from inception to June 2023. Articles were included if they described or mentioned the use of paracervical block in the context of HDR brachytherapy for cervix cancer. Non-English language or abstract-only articles were excluded. Citations were reviewed for relevant papers. Pain control and toxicity outcomes were abstracted along with technical details of anesthesia and brachytherapy procedure.
RESULTS
Of the 396 articles identified, eight were included. Two gave general recommendations around the role of paracervical block. The rest described its use during brachytherapy at their respective institutions. There was heterogeneity in paracervical block technique across different publications. The majority of included articles describe use of paracervical block for procedural pain control, while only one describe its use for postprocedure pain control. Pain was well controlled with <10% of patients experiencing moderate or higher pain. However, there were no studies specifically assessing pain management with versus without use of paracervical block. The rate of grade 3+ toxicity associated with its use was <5%.
CONCLUSIONS
Paracervical block is safe and can be part of effective pain management for patients receiving cervical brachytherapy. However, the incremental benefit of adding paracervical block is not well assessed in the current literature.
{"title":"Understanding the value of paracervical block during gynecologic brachytherapy: A systematic review of the literature","authors":"Stephanie Gulstene , Razan Amjad , Lucas C. Mendez","doi":"10.1016/j.brachy.2025.04.008","DOIUrl":"10.1016/j.brachy.2025.04.008","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Paracervical block<span><span><span> is a technique to provide local anesthesia<span> with evidence supporting its use for various gynecologic procedures; however, the literature on its use for gynecologic brachytherapy is limited. This </span></span>systematic review seeks to understand the efficacy and safety of paracervical block in </span>cervical cancer brachytherapy.</span></div></div><div><h3>METHODS</h3><div>PubMed and EMBASE/Cochrane Library databases were searched from inception to June 2023. Articles were included if they described or mentioned the use of paracervical block in the context of HDR brachytherapy for cervix cancer. Non-English language or abstract-only articles were excluded. Citations were reviewed for relevant papers. Pain control and toxicity outcomes were abstracted along with technical details of anesthesia and brachytherapy procedure.</div></div><div><h3>RESULTS</h3><div>Of the 396 articles identified, eight were included. Two gave general recommendations around the role of paracervical block. The rest described its use during brachytherapy at their respective institutions. There was heterogeneity in paracervical block technique across different publications. The majority of included articles describe use of paracervical block for procedural pain control, while only one describe its use for postprocedure pain control. Pain was well controlled with <10% of patients experiencing moderate or higher pain. However, there were no studies specifically assessing pain management with versus without use of paracervical block. The rate of grade 3+ toxicity associated with its use was <5%.</div></div><div><h3>CONCLUSIONS</h3><div>Paracervical block is safe and can be part of effective pain management for patients receiving cervical brachytherapy. However, the incremental benefit of adding paracervical block is not well assessed in the current literature.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 5","pages":"Pages 694-702"},"PeriodicalIF":1.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.03.002
Ria Mulherkar , David Grimm , Paniti Sukumvanich , Madeleine Courtney-Brooks , Michelle Boisen , Jessica Berger , Sarah Taylor , Jamie Lesnock , Shannon Rush , Allison Garrett , Haider Mahdi , John Comerci , Alexander Olaiwaye , Robert Edwards , Elangovan Doraisamy , Michael Hajduk , Christopher J. Houser , Hayeon Kim , John Austin Vargo IV
INTRODUCTION
Several factors of template-based interstitial brachytherapy in gynecologic cancers, including large tumor size, invasion into adjacent organs or fistula, dose heterogeneity, and twice daily fractionation cause inherent dose-escalation effects, potentially increasing toxicity. This study reports a single-institutional dose escalation experience in twice daily template-based interstitial brachytherapy treatments to demonstrate tumor control and toxicity outcomes, with the hypothesis that with image-based planning dose-escalation with interstitial brachytherapy is safe and efficacious.
METHODS
Patients treated with template-based interstitial brachytherapy at our institution from 2006 to 2022 were identified. Over time, HDR brachytherapy boost dose at our institution has been dose-escalated from 18.75 Gy in 5 fractions to 27.5 Gy in 5 fractions. Local control and survival outcomes were analyzed using the Kaplan–Meier method and log-rank test to compare between groups. Formal tumor control probability (TCP) analysis was performed using logistic dose-response modeling.
RESULTS
214 patients were identified with median follow-up of 28.1 months (IQR 8.2–58.7). Total HDR dose correlated significantly with local and locoregional control when analyzed as a continuous variable, and when dichotomized around median dose of 25 Gy (p = 0.024). TCP analysis showed a dose-response effect between HR CTV D90 and local control in the entire cohort, and separately in cervical and vaginal cancer subsets. The actuarial 5-year incidence of grade 3 or worse toxicity was 6.1%, and there was no significant association between toxicity and total HDR dose or HR CTV D90.
CONCLUSION
In patient treated with twice-daily template-based interstitial brachytherapy for gynecologic cancers brachytherapy dose correlates with local control with no significant association between brachytherapy dose and toxicity, thus suggesting room for dose-escalation.
{"title":"Twice daily template-based interstitial brachytherapy for gynecologic cancers: What is the optimal dose?","authors":"Ria Mulherkar , David Grimm , Paniti Sukumvanich , Madeleine Courtney-Brooks , Michelle Boisen , Jessica Berger , Sarah Taylor , Jamie Lesnock , Shannon Rush , Allison Garrett , Haider Mahdi , John Comerci , Alexander Olaiwaye , Robert Edwards , Elangovan Doraisamy , Michael Hajduk , Christopher J. Houser , Hayeon Kim , John Austin Vargo IV","doi":"10.1016/j.brachy.2025.03.002","DOIUrl":"10.1016/j.brachy.2025.03.002","url":null,"abstract":"<div><h3>INTRODUCTION</h3><div>Several factors of template-based interstitial brachytherapy in gynecologic cancers, including large tumor size, invasion into adjacent organs or fistula, dose heterogeneity, and twice daily fractionation cause inherent dose-escalation effects, potentially increasing toxicity. This study reports a single-institutional dose escalation experience in twice daily template-based interstitial brachytherapy treatments to demonstrate tumor control and toxicity outcomes, with the hypothesis that with image-based planning dose-escalation with interstitial brachytherapy is safe and efficacious.</div></div><div><h3>METHODS</h3><div>Patients treated with template-based interstitial brachytherapy at our institution from 2006 to 2022 were identified. Over time, HDR brachytherapy boost dose at our institution has been dose-escalated from 18.75 Gy in 5 fractions to 27.5 Gy in 5 fractions. Local control and survival outcomes were analyzed using the Kaplan–Meier method and log-rank test to compare between groups. Formal tumor control probability (TCP) analysis was performed using logistic dose-response modeling.</div></div><div><h3>RESULTS</h3><div>214 patients were identified with median follow-up of 28.1 months (IQR 8.2–58.7). Total HDR dose correlated significantly with local and locoregional control when analyzed as a continuous variable, and when dichotomized around median dose of 25 Gy (<em>p</em> = 0.024). TCP analysis showed a dose-response effect between HR CTV D90 and local control in the entire cohort, and separately in cervical and vaginal cancer subsets. The actuarial 5-year incidence of grade 3 or worse toxicity was 6.1%, and there was no significant association between toxicity and total HDR dose or HR CTV D90.</div></div><div><h3>CONCLUSION</h3><div>In patient treated with twice-daily template-based interstitial brachytherapy for gynecologic cancers brachytherapy dose correlates with local control with no significant association between brachytherapy dose and toxicity, thus suggesting room for dose-escalation.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages 495-503"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ureteric stenosis is a known complication with radiotherapy with studies showing correlation of ureteric dose with stenosis. This study was done to assess the dose delivered to the ureters with and without ureter as avoidance organ in cervical cancer patients treated with hybrid brachytherapy.
MATERIAL AND METHODS
Cervical cancer patients treated with EBRT and MR hybrid brachytherapy were retrospectively analyzed. They were treated without ureter contoured as organ at risk. The right and left ureters were retrospectively contoured on T2 weighted MRI images. Dose to 0.1cc volume of ureter was documented.
RESULTS
26 patients treated with hybrid brachytherapy were analyzed. The median HRCTV volume was 23.9cc. The median HRCTV D90 & GTV D98 EQD2 were 91.09Gy (IQR 92.36–87.28) and 104.67Gy (IQR 113.90–95.04) respectively. The median D2cc for bladder, rectum and sigmoid were 75.46Gy, 58.10Gy and 61.3Gy EQD2 respectively. The mean minimum distance of the left ureter from HRCTV was 3.2mm (IQR 6.75–1) & right ureter was 2.3mm (IQR 8–0). The mean D0.1cc to the left ureter was 75.16Gy EQD2 (IQR 88.28–58.20) and to the right ureter was 69.73Gy EQD2 (IQR 76.77–56.01). The ureter D0.1cc exceeded 77Gy in 13/26 patients. Replanning and reducing needle loading near the ureter resulted in reduction of ureter 0.1cc dose to less than 77Gy in all but 2 patients, without compromising the HRCTV coverage.
CONCLUSION
The ureter is at risk of receiving high doses when we use hybrid applicator. MR planning to delineate the ureter and careful optimization of needles can result in significant reduction of ureter dose with similar target coverage.
{"title":"A dosimetric evaluation of ureteric doses with and without ureter as avoidance organ in patients treated with MR hybrid brachytherapy for cervical cancer","authors":"Harjot Kaur Bajwa , Sushil Beriwal , Rajesh Natte , Racharla Chandra Kumar , Rampally Kumar , Suresh Chaudhari","doi":"10.1016/j.brachy.2025.02.007","DOIUrl":"10.1016/j.brachy.2025.02.007","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Ureteric stenosis is a known complication with radiotherapy with studies showing correlation of ureteric dose with stenosis. This study was done to assess the dose delivered to the ureters with and without ureter as avoidance organ in cervical cancer patients treated with hybrid brachytherapy.</div></div><div><h3>MATERIAL AND METHODS</h3><div>Cervical cancer patients treated with EBRT and MR hybrid brachytherapy were retrospectively analyzed. They were treated without ureter contoured as organ at risk. The right and left ureters were retrospectively contoured on T2 weighted MRI images. Dose to 0.1cc volume of ureter was documented.</div></div><div><h3>RESULTS</h3><div>26 patients treated with hybrid brachytherapy were analyzed. The median HRCTV volume was 23.9cc. The median HRCTV D90 & GTV D98 EQD2 were 91.09Gy (IQR 92.36–87.28) and 104.67Gy (IQR 113.90–95.04) respectively. The median D2cc for bladder, rectum and sigmoid were 75.46Gy, 58.10Gy and 61.3Gy EQD2 respectively. The mean minimum distance of the left ureter from HRCTV was 3.2mm (IQR 6.75–1) & right ureter was 2.3mm (IQR 8–0). The mean D<sub>0.1cc</sub> to the left ureter was 75.16Gy EQD2 (IQR 88.28–58.20) and to the right ureter was 69.73Gy EQD2 (IQR 76.77–56.01). The ureter D<sub>0.1cc</sub> exceeded 77Gy in 13/26 patients. Replanning and reducing needle loading near the ureter resulted in reduction of ureter 0.1cc dose to less than 77Gy in all but 2 patients, without compromising the HRCTV coverage.</div></div><div><h3>CONCLUSION</h3><div>The ureter is at risk of receiving high doses when we use hybrid applicator. MR planning to delineate the ureter and careful optimization of needles can result in significant reduction of ureter dose with similar target coverage.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages 504-509"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.014
Claire Zhang PhD , Shiqin Su PhD , Choonik Lee PhD , Elizabeth Jaworski MD , Shruti Jolly MD , Joseph Evans MD , Joann Prisciandaro PhD
<div><h3>Purpose</h3><div>Interstitial gynecologic (GYN) brachytherapy is an effective treatment for endometrial and cervical cancers, but conventional forward planning is technically challenging, time-consuming, and often requires expertise and skills. Over the past decade, inverse planning has gained popularity, showing potential to improve efficiency and plan quality. We present a standardized inverse planning workflow for multi-dose-level interstitial GYN brachytherapy, utilizing the VEGO optimization algorithm (Eclipse v16). The workflow aims to enhance planning consistency and robustness while minimizing manual intervention, thereby reducing dependence on planners’ clinical experience, which has historically been a significant barrier to the adoption of interstitial brachytherapy.</div></div><div><h3>Materials and Methods</h3><div>The workflow (Figure 1a) involves creating optimization structures including ring structures (1 cm margin around the CTV, excluding overlaps with OARs) and a dwell position structure (zDwell) combining all CTVs with a 1 cm margin. Initial dwell positions are defined within zDwell, and a standardized objective template was applied in VEGO TG43 inverse planning. This STAMP (structure- and template-assisted multi-dose-level planning) approach was retrospectively applied to 26 GYN interstitial brachytherapy patients at a single institution. The median high-risk CTV (CTV_HR) prescription was 26 Gy (range: 22.4-30 Gy) over four fractions, with 15 patients also receiving 14 Gy (range: 4.8-24 Gy) for intermediate-risk CTVs (CTV_IR). EMBRACE II constraints guided OAR planning objectives, and plans were normalized to achieve CTV_HR D90=100%. STAMP plans, generated without manual dwell time adjustments, were compared to clinical plans in total OAR D2cc (EBRT + brachytherapy, estimating maximum possible D2cc), D90 of CTV_IR, and total dwell time. A two-sided Wilcoxon rank-sum test was used to assess statistical significance (p=0.05).</div></div><div><h3>Results</h3><div>The median (range) number of optimization iterations for all STAMP plans was 4 (1-7). Both clinical and STAMP plans met EMBRACE I dose constraints for all OARs. Among the twenty-six cases, the number of clinical plans failing to meet EMBRACE II limits for the bladder, rectum, sigmoid, and bowel were 9, 16, 3, and 5, respectively, compared to 8, 13, 2, and 5 for STAMP plans (clinical plans aimed to meet EMBRACE II goals; however, some constraints were not achievable due to clinical considerations). All cases achieved CTV_HR D90=100% coverage. For the 15 cases with a CTV_IR prescription, 3/15 clinical plans failed to achieve D90 > 100%, while all STAMP plans met this criterion. Boxplots in Figure 1b-d compare OAR doses, CTV_IR coverage (D90), and total dwell time between clinical and STAMP plans. STAMP plans showed slightly lower OAR doses (except for the bowel) and shorter total dwell times. CTV_IR coverage was comparable between the two plans, with STAMP sh
{"title":"GPP03 Presentation Time: 9:33 AM","authors":"Claire Zhang PhD , Shiqin Su PhD , Choonik Lee PhD , Elizabeth Jaworski MD , Shruti Jolly MD , Joseph Evans MD , Joann Prisciandaro PhD","doi":"10.1016/j.brachy.2025.06.014","DOIUrl":"10.1016/j.brachy.2025.06.014","url":null,"abstract":"<div><h3>Purpose</h3><div>Interstitial gynecologic (GYN) brachytherapy is an effective treatment for endometrial and cervical cancers, but conventional forward planning is technically challenging, time-consuming, and often requires expertise and skills. Over the past decade, inverse planning has gained popularity, showing potential to improve efficiency and plan quality. We present a standardized inverse planning workflow for multi-dose-level interstitial GYN brachytherapy, utilizing the VEGO optimization algorithm (Eclipse v16). The workflow aims to enhance planning consistency and robustness while minimizing manual intervention, thereby reducing dependence on planners’ clinical experience, which has historically been a significant barrier to the adoption of interstitial brachytherapy.</div></div><div><h3>Materials and Methods</h3><div>The workflow (Figure 1a) involves creating optimization structures including ring structures (1 cm margin around the CTV, excluding overlaps with OARs) and a dwell position structure (zDwell) combining all CTVs with a 1 cm margin. Initial dwell positions are defined within zDwell, and a standardized objective template was applied in VEGO TG43 inverse planning. This STAMP (structure- and template-assisted multi-dose-level planning) approach was retrospectively applied to 26 GYN interstitial brachytherapy patients at a single institution. The median high-risk CTV (CTV_HR) prescription was 26 Gy (range: 22.4-30 Gy) over four fractions, with 15 patients also receiving 14 Gy (range: 4.8-24 Gy) for intermediate-risk CTVs (CTV_IR). EMBRACE II constraints guided OAR planning objectives, and plans were normalized to achieve CTV_HR D90=100%. STAMP plans, generated without manual dwell time adjustments, were compared to clinical plans in total OAR D2cc (EBRT + brachytherapy, estimating maximum possible D2cc), D90 of CTV_IR, and total dwell time. A two-sided Wilcoxon rank-sum test was used to assess statistical significance (p=0.05).</div></div><div><h3>Results</h3><div>The median (range) number of optimization iterations for all STAMP plans was 4 (1-7). Both clinical and STAMP plans met EMBRACE I dose constraints for all OARs. Among the twenty-six cases, the number of clinical plans failing to meet EMBRACE II limits for the bladder, rectum, sigmoid, and bowel were 9, 16, 3, and 5, respectively, compared to 8, 13, 2, and 5 for STAMP plans (clinical plans aimed to meet EMBRACE II goals; however, some constraints were not achievable due to clinical considerations). All cases achieved CTV_HR D90=100% coverage. For the 15 cases with a CTV_IR prescription, 3/15 clinical plans failed to achieve D90 > 100%, while all STAMP plans met this criterion. Boxplots in Figure 1b-d compare OAR doses, CTV_IR coverage (D90), and total dwell time between clinical and STAMP plans. STAMP plans showed slightly lower OAR doses (except for the bowel) and shorter total dwell times. CTV_IR coverage was comparable between the two plans, with STAMP sh","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S9-S10"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.015
Santino Butler MD, Nikhil Kotha MD, Thomas Niedermayr PhD, Elizabeth Kidd MD
<div><h3>Purpose</h3><div>Locally advanced cervical cancers can particularly benefit from the addition of interstitial needles during brachytherapy. We designed a three-dimensionally (3D)-printed ovoid-based needle guide (OVI)—which contains medial and lateral needle channels, and can also function in conjunction with 3D-printed tandem-based needle templates — to create a tool to aid needle placement. Example OVI implant shown in Fig. 1A. This study aimed to evaluate the dosimetric advantages from utilizing OVI, and determine which patients benefit most.</div></div><div><h3>Materials and Methods</h3><div>This single institution cohort study included 88 cervical brachytherapy implants (OVI, N=77; non-OVI, N=11) across 22 patients treated definitively with OVI for ≥2 fractions from 2020 to 2024. Dose and clinical features were compared across implants and tumor-score (T-score: an EMBRACE-validated prognostic tumor score shown to outperform FIGO stage in predicting for local control and survival). Logistic regression analyzed predictors of high-risk clinical target volume (HR-CTV) dose (each fraction analyzed separately using predicted cumulative D90 [assuming identical dose for all fractions]).</div></div><div><h3>Results</h3><div>Sixty-four percent of patients received OVI for all four implants (all-OVI), and 36% received OVI for 2-3 implants (part-OVI). There were no significant differences between all-OVI and part-OVI patients with respect to FIGO 2014 stage, pre-HDR tumor size, HR-CTV width at cervical os, HR-CTV volume, or T-score. Overall, 64% had FIGO III-IV [41% FIGO IV], 73% HR-CTV volume >30cc, and 41% T-score ≥10; median width at cervical os was 4.8 cm (range, 3.6-6.5 cm). FIGO IV disease and HR-CTV volume ≥30cc were associated with higher T-scores (P<0.001 for both). However, with respect to HR-CTV dose achieved, T-score ≥10 (vs <10) was the most predictive variable for lower mean D90 (-4.1 Gy<sub>EQD2</sub>, P<0.001), compared to FIGO IV (vs I-III; -2.9 Gy<sub>EQD2</sub>, P=0.001) and HR-CTV volume >30cc (vs ≤30cc; -0.2 Gy<sub>EQD2</sub>, P=0.86). Tumors with T-score ≥10 were also less likely to achieve D90 >85 Gy (58.3% vs 86.5%, P=0.005). OVI implants had a higher mean D90 (88.7 vs 80.1 Gy<sub>EQD2</sub>, P<0.001) and remained more likely than non-OVI to achieve D90 >85 Gy (83.1% vs 18.2%; aOR 13.8 [95% CI, 2.44-78.5] P=0.003) after adjusting for implant year and T-score. OVI (vs non-OVI) implants had no difference in mean dose to rectum (D2cc<sub>rectum</sub>: 66.0 vs 64.9 [+1.1 Gy<sub>EQD2</sub>] P=0.58) or bladder (D2cc<sub>bladder</sub>: 83.2 vs 81.0 [+2.2 Gy<sub>EQD2</sub>] P=0.24), but had a trend towards improved bowel dose (D2cc<sub>bowel</sub>: 67.2 vs 72.1 [-4.9 Gy<sub>EQD2</sub>] P=0.066). With respect to HR-CTV D90 achieved (Fig 1B), fractions utilizing OVI had the greatest relative benefit for tumors with T score ≥ 10. For non-OVI fractions, mean D90 was 8.4 Gy<sub>EQD2</sub> lower (P=0.03) for T-
{"title":"GPP04 Presentation Time: 9:42 AM","authors":"Santino Butler MD, Nikhil Kotha MD, Thomas Niedermayr PhD, Elizabeth Kidd MD","doi":"10.1016/j.brachy.2025.06.015","DOIUrl":"10.1016/j.brachy.2025.06.015","url":null,"abstract":"<div><h3>Purpose</h3><div>Locally advanced cervical cancers can particularly benefit from the addition of interstitial needles during brachytherapy. We designed a three-dimensionally (3D)-printed ovoid-based needle guide (OVI)—which contains medial and lateral needle channels, and can also function in conjunction with 3D-printed tandem-based needle templates — to create a tool to aid needle placement. Example OVI implant shown in Fig. 1A. This study aimed to evaluate the dosimetric advantages from utilizing OVI, and determine which patients benefit most.</div></div><div><h3>Materials and Methods</h3><div>This single institution cohort study included 88 cervical brachytherapy implants (OVI, N=77; non-OVI, N=11) across 22 patients treated definitively with OVI for ≥2 fractions from 2020 to 2024. Dose and clinical features were compared across implants and tumor-score (T-score: an EMBRACE-validated prognostic tumor score shown to outperform FIGO stage in predicting for local control and survival). Logistic regression analyzed predictors of high-risk clinical target volume (HR-CTV) dose (each fraction analyzed separately using predicted cumulative D90 [assuming identical dose for all fractions]).</div></div><div><h3>Results</h3><div>Sixty-four percent of patients received OVI for all four implants (all-OVI), and 36% received OVI for 2-3 implants (part-OVI). There were no significant differences between all-OVI and part-OVI patients with respect to FIGO 2014 stage, pre-HDR tumor size, HR-CTV width at cervical os, HR-CTV volume, or T-score. Overall, 64% had FIGO III-IV [41% FIGO IV], 73% HR-CTV volume >30cc, and 41% T-score ≥10; median width at cervical os was 4.8 cm (range, 3.6-6.5 cm). FIGO IV disease and HR-CTV volume ≥30cc were associated with higher T-scores (P<0.001 for both). However, with respect to HR-CTV dose achieved, T-score ≥10 (vs <10) was the most predictive variable for lower mean D90 (-4.1 Gy<sub>EQD2</sub>, P<0.001), compared to FIGO IV (vs I-III; -2.9 Gy<sub>EQD2</sub>, P=0.001) and HR-CTV volume >30cc (vs ≤30cc; -0.2 Gy<sub>EQD2</sub>, P=0.86). Tumors with T-score ≥10 were also less likely to achieve D90 >85 Gy (58.3% vs 86.5%, P=0.005). OVI implants had a higher mean D90 (88.7 vs 80.1 Gy<sub>EQD2</sub>, P<0.001) and remained more likely than non-OVI to achieve D90 >85 Gy (83.1% vs 18.2%; aOR 13.8 [95% CI, 2.44-78.5] P=0.003) after adjusting for implant year and T-score. OVI (vs non-OVI) implants had no difference in mean dose to rectum (D2cc<sub>rectum</sub>: 66.0 vs 64.9 [+1.1 Gy<sub>EQD2</sub>] P=0.58) or bladder (D2cc<sub>bladder</sub>: 83.2 vs 81.0 [+2.2 Gy<sub>EQD2</sub>] P=0.24), but had a trend towards improved bowel dose (D2cc<sub>bowel</sub>: 67.2 vs 72.1 [-4.9 Gy<sub>EQD2</sub>] P=0.066). With respect to HR-CTV D90 achieved (Fig 1B), fractions utilizing OVI had the greatest relative benefit for tumors with T score ≥ 10. For non-OVI fractions, mean D90 was 8.4 Gy<sub>EQD2</sub> lower (P=0.03) for T-","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S10-S11"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.059
Cody Robert Kilar DO, PhD , Adrian Cozma MD , Arjit Baghwala MS , Andrew Farach MD
Purpose
Keratinocyte carcinoma (KC) is estimated to be the most common cancer in the United States. Current American Brachytherapy Society and GEC-ESTRO consensus guidelines recommend the use of interstitial high-dose-rate (HDR) brachytherapy for tumors deeper than 5mm. In this case series, we describe the feasibility and efficacy of utilizing superficial radionucleotide-based high-dose rate brachytherapy for deep (> 5mm) KC.
Materials and Methods
This case series included four patients with pathologically confirmed KC treated at a single institution. All patients received 40 Gy delivered in 8 fractions, with treatments being administered twice per week. For deep skin lesions in three patients, a custom, in-house multichannel flap applicator with a 1 cm source-to-skin distance was used to take advantage of the less pronounced dose falloff. This approach ensured that the dose remained sufficient at depth to treat the lesion effectively, while limiting V150 to superficial tissues. One patient was treated with a custom, in-house multichannel flap applicator with a standard 0.5 cm source-to-skin distance due to the lesion being on the upper lip, where limiting dose penetration was a priority. All patients had individualized CT-based planning to ensure complete tumor coverage. Dosimetric parameters V150, D95%, mean dose, and max dose were analyzed.
Results
4 patients completed superficial radionucleotide-based HDR skin brachytherapy with curative intent between March 2019 to November 2023. Median patient age was 90.22 (range = 81-95) and median depth of tumor was 7.6 mm (range = 5.6-10.8). For all patients, the median V150 was 0.0057cc (range = 0-0.09cc). Median D95% was 95.1% of the prescribed dose (range = 94.9-102.4%). Median mean dose was 44.72 Gy (range = 41.61-48.38 Gy). Median maximal dose was 71.24 Gy (range = 52.23-87.45 Gy). There were no Grade 3 or higher acute toxicities reported.
Conclusions
This case series finds that superficial radionucleotide-based HDR skin brachytherapy for deep (>5mm) KC is a safe and feasible for patients. Additionally, this series highlights that a 1 cm source-to-skin applicator is better suited for lesions with significant depth, optimizing dose distribution according to the inverse-square law while preserving safety and effectiveness. In this patient population, with short follow-up period, the control rates and acute toxicity profile appear to be acceptable. Future prospective studies are needed to confirm efficacy.
{"title":"MSOP10 Presentation Time: 8:45 AM","authors":"Cody Robert Kilar DO, PhD , Adrian Cozma MD , Arjit Baghwala MS , Andrew Farach MD","doi":"10.1016/j.brachy.2025.06.059","DOIUrl":"10.1016/j.brachy.2025.06.059","url":null,"abstract":"<div><h3>Purpose</h3><div>Keratinocyte carcinoma (KC) is estimated to be the most common cancer in the United States. Current American Brachytherapy Society and GEC-ESTRO consensus guidelines recommend the use of interstitial high-dose-rate (HDR) brachytherapy for tumors deeper than 5mm. In this case series, we describe the feasibility and efficacy of utilizing superficial radionucleotide-based high-dose rate brachytherapy for deep (> 5mm) KC.</div></div><div><h3>Materials and Methods</h3><div>This case series included four patients with pathologically confirmed KC treated at a single institution. All patients received 40 Gy delivered in 8 fractions, with treatments being administered twice per week. For deep skin lesions in three patients, a custom, in-house multichannel flap applicator with a 1 cm source-to-skin distance was used to take advantage of the less pronounced dose falloff. This approach ensured that the dose remained sufficient at depth to treat the lesion effectively, while limiting V150 to superficial tissues. One patient was treated with a custom, in-house multichannel flap applicator with a standard 0.5 cm source-to-skin distance due to the lesion being on the upper lip, where limiting dose penetration was a priority. All patients had individualized CT-based planning to ensure complete tumor coverage. Dosimetric parameters V150, D95%, mean dose, and max dose were analyzed.</div></div><div><h3>Results</h3><div>4 patients completed superficial radionucleotide-based HDR skin brachytherapy with curative intent between March 2019 to November 2023. Median patient age was 90.22 (range = 81-95) and median depth of tumor was 7.6 mm (range = 5.6-10.8). For all patients, the median V150 was 0.0057cc (range = 0-0.09cc). Median D95% was 95.1% of the prescribed dose (range = 94.9-102.4%). Median mean dose was 44.72 Gy (range = 41.61-48.38 Gy). Median maximal dose was 71.24 Gy (range = 52.23-87.45 Gy). There were no Grade 3 or higher acute toxicities reported.</div></div><div><h3>Conclusions</h3><div>This case series finds that superficial radionucleotide-based HDR skin brachytherapy for deep (>5mm) KC is a safe and feasible for patients. Additionally, this series highlights that a 1 cm source-to-skin applicator is better suited for lesions with significant depth, optimizing dose distribution according to the inverse-square law while preserving safety and effectiveness. In this patient population, with short follow-up period, the control rates and acute toxicity profile appear to be acceptable. Future prospective studies are needed to confirm efficacy.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S34-S35"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.084
Travis Lambert MD, Lee Goddard PhD, Keyur Mehta MD
<div><h3>Purpose</h3><div>Image-guided brachytherapy (IGBT) has become the standard of care in cervical cancer treatment, demonstrating trends toward improved local tumor control and overall survival while reducing treatment-related toxicity compared to conventional two-dimensional brachytherapy techniques. This current brachytherapy approach for cervical cancer requires the placement of large, rigid intracavitary applicators, which remain in place for extended periods—often an hour or more—which can cause significant patient discomfort. Prior studies have documented patient-reported morbidity, including pain, anxiety, discomfort, and, in some cases, post-traumatic stress disorder following these procedures. To address these challenges, we have developed a customizable, 3D-printed long-temporary implantable (3D-printed LTI) device designed to improve patient quality of life and treatment experience while maintaining or improving dosimetric efficacy. The proposed device can be 3D printed in our department based on patient-specific anatomical and tumor geometry. The design incorporates a central tandem connected to a cervical cone which extends around the cervix. There are multiple channels that can accommodate interstitial needles or serve as conduits for flexible catheter placement. This device is implanted in the operating room and remains in place throughout treatments, allowing for access via small catheters on treatment days. Upon completion of treatments, it will be removed in the outpatient setting and discarded. This study aims to evaluate the dosimetric distribution of the 3D-printed LTI device compared to standard intracavitary applicators. We hypothesize that the new device will achieve comparable or superior target volume coverage while optimizing organ-at-risk (OAR) sparing.</div></div><div><h3>Materials and Methods</h3><div>The 3D-printed LTI device was implanted into a gynecologic phantom, which is a specialized anatomical model replicating the human pelvic anatomy. Computed tomography (CT), images of the device within the phantom were acquired. To establish a baseline, the same procedure was conducted with existing standard-of-care gynecologic brachytherapy applicators, specifically the Geneva tandem and ovoid (T&O) and Venezia tandem and partial ring (T&R) applicators. The CT images were registered to an existing patient contour set, based on the tandem orientation and cervical OS position. These contour sets were then transferred to the Oncentra treatment planning system (TPS), and treatment plans were generated for each applicator to maximize target dose and minimize dose to the surrounding organs at risk (OARs). This step allowed a comprehensive comparison of the dose distributions delivered by the prototype and the standard applicators, providing a three-dimensional view of how each system interacts with the surrounding tissue model.</div></div><div><h3>Results</h3><div>The volume of the high-risk CTV (HR-CTV) receivin
{"title":"GSOR03 Presentation Time: 11:40 AM","authors":"Travis Lambert MD, Lee Goddard PhD, Keyur Mehta MD","doi":"10.1016/j.brachy.2025.06.084","DOIUrl":"10.1016/j.brachy.2025.06.084","url":null,"abstract":"<div><h3>Purpose</h3><div>Image-guided brachytherapy (IGBT) has become the standard of care in cervical cancer treatment, demonstrating trends toward improved local tumor control and overall survival while reducing treatment-related toxicity compared to conventional two-dimensional brachytherapy techniques. This current brachytherapy approach for cervical cancer requires the placement of large, rigid intracavitary applicators, which remain in place for extended periods—often an hour or more—which can cause significant patient discomfort. Prior studies have documented patient-reported morbidity, including pain, anxiety, discomfort, and, in some cases, post-traumatic stress disorder following these procedures. To address these challenges, we have developed a customizable, 3D-printed long-temporary implantable (3D-printed LTI) device designed to improve patient quality of life and treatment experience while maintaining or improving dosimetric efficacy. The proposed device can be 3D printed in our department based on patient-specific anatomical and tumor geometry. The design incorporates a central tandem connected to a cervical cone which extends around the cervix. There are multiple channels that can accommodate interstitial needles or serve as conduits for flexible catheter placement. This device is implanted in the operating room and remains in place throughout treatments, allowing for access via small catheters on treatment days. Upon completion of treatments, it will be removed in the outpatient setting and discarded. This study aims to evaluate the dosimetric distribution of the 3D-printed LTI device compared to standard intracavitary applicators. We hypothesize that the new device will achieve comparable or superior target volume coverage while optimizing organ-at-risk (OAR) sparing.</div></div><div><h3>Materials and Methods</h3><div>The 3D-printed LTI device was implanted into a gynecologic phantom, which is a specialized anatomical model replicating the human pelvic anatomy. Computed tomography (CT), images of the device within the phantom were acquired. To establish a baseline, the same procedure was conducted with existing standard-of-care gynecologic brachytherapy applicators, specifically the Geneva tandem and ovoid (T&O) and Venezia tandem and partial ring (T&R) applicators. The CT images were registered to an existing patient contour set, based on the tandem orientation and cervical OS position. These contour sets were then transferred to the Oncentra treatment planning system (TPS), and treatment plans were generated for each applicator to maximize target dose and minimize dose to the surrounding organs at risk (OARs). This step allowed a comprehensive comparison of the dose distributions delivered by the prototype and the standard applicators, providing a three-dimensional view of how each system interacts with the surrounding tissue model.</div></div><div><h3>Results</h3><div>The volume of the high-risk CTV (HR-CTV) receivin","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S50-S51"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Purpose</h3><div>Challenges in radiotherapy, including brachytherapy, during the first year of the war in Ukraine were presented and discussed at ABS meetings in 2023. Despite ongoing conflict, Ukraine is committed to maintaining radiation therapy services. In 2023, the Ministry of Health signed a contract to deliver 15 linear accelerators (linacs), which will help transition from 2D and 3D treatments and move away from Co-60 in external beam radiation therapy (EBRT). Some centers are also updating their brachytherapy systems; however, in general development of brachytherapy has not been considered a priority. At the conflict's onset, the supply of Ir-192 sources was disrupted due to logistical issues. While this has since been normalized, the reliance on outdated Cobalt machines in brachytherapy remains an issue. More than three-quarters of the 29 operational brachytherapy units in Ukraine use Co-60 sources, and most of these outdated systems cannot be recharged. The AGAT models Co-60 machines are also without any planning systems. According to DIRAC data, Ukraine has 36 brachytherapy units, but actually, 7 of these are currently not in operation for radiotherapy. This study assesses the current state of brachytherapy in Ukraine and explores opportunities for its modernization.</div></div><div><h3>Materials and Methods</h3><div>A survey was conducted among RT departments in Ukraine to evaluate the state of brachytherapy across the country. Questions ranged from equipment status, cancer sites treated, patient workload, applicator sufficiency, and interest in expanding brachytherapy techniques. Equipment data was compared with DIRAC system records. Additionally, a global literature review was performed to identify best practices and emerging brachytherapy trends relevant to Ukraine’s needs.</div></div><div><h3>Results</h3><div>Seventeen RT departments responded to the survey (response rate of 94.4%) reporting the presence of 21 HDR afterloaders (66.7% Co-60 and 33.3% Ir-192). Fig. 1. shows geographic distribution of HDR brachytherapy programs in Ukraine. Based on the survey, the average age of commissioned brachytherapy equipment in Ukraine is 22.5±11.3 (range, 1-40) years. Three centers are in the process of updating their services. On average, each center treats 11.1±7.4 patients per week, primarily for gynecological cancers, with limited interstitial brachytherapy applications. Only 22% of centers consider their applicator sets sufficient, and only 23% perform any non GYN brachytherapy. No centers in the country are performing prostate brachytherapy. Despite the war and infrastructure challenges, 83% of the survey respondents expressed interest in expanding brachytherapy techniques and 41% of respondents reported an increase in brachytherapy patient volume. Globally, brachytherapy's use has declined for some cancer types, yet it remains highly relevant for treating prostate, skin, breast, sarcoma and gastrointestinal cancers, as confir
{"title":"MSOP08 Presentation Time: 5:35 PM","authors":"Zoia Shepil MD , Serhii Brovchuk PhD , Puja Venkat MD , Sang-June Park PhD , Nataliya Kovalchuk PhD","doi":"10.1016/j.brachy.2025.06.043","DOIUrl":"10.1016/j.brachy.2025.06.043","url":null,"abstract":"<div><h3>Purpose</h3><div>Challenges in radiotherapy, including brachytherapy, during the first year of the war in Ukraine were presented and discussed at ABS meetings in 2023. Despite ongoing conflict, Ukraine is committed to maintaining radiation therapy services. In 2023, the Ministry of Health signed a contract to deliver 15 linear accelerators (linacs), which will help transition from 2D and 3D treatments and move away from Co-60 in external beam radiation therapy (EBRT). Some centers are also updating their brachytherapy systems; however, in general development of brachytherapy has not been considered a priority. At the conflict's onset, the supply of Ir-192 sources was disrupted due to logistical issues. While this has since been normalized, the reliance on outdated Cobalt machines in brachytherapy remains an issue. More than three-quarters of the 29 operational brachytherapy units in Ukraine use Co-60 sources, and most of these outdated systems cannot be recharged. The AGAT models Co-60 machines are also without any planning systems. According to DIRAC data, Ukraine has 36 brachytherapy units, but actually, 7 of these are currently not in operation for radiotherapy. This study assesses the current state of brachytherapy in Ukraine and explores opportunities for its modernization.</div></div><div><h3>Materials and Methods</h3><div>A survey was conducted among RT departments in Ukraine to evaluate the state of brachytherapy across the country. Questions ranged from equipment status, cancer sites treated, patient workload, applicator sufficiency, and interest in expanding brachytherapy techniques. Equipment data was compared with DIRAC system records. Additionally, a global literature review was performed to identify best practices and emerging brachytherapy trends relevant to Ukraine’s needs.</div></div><div><h3>Results</h3><div>Seventeen RT departments responded to the survey (response rate of 94.4%) reporting the presence of 21 HDR afterloaders (66.7% Co-60 and 33.3% Ir-192). Fig. 1. shows geographic distribution of HDR brachytherapy programs in Ukraine. Based on the survey, the average age of commissioned brachytherapy equipment in Ukraine is 22.5±11.3 (range, 1-40) years. Three centers are in the process of updating their services. On average, each center treats 11.1±7.4 patients per week, primarily for gynecological cancers, with limited interstitial brachytherapy applications. Only 22% of centers consider their applicator sets sufficient, and only 23% perform any non GYN brachytherapy. No centers in the country are performing prostate brachytherapy. Despite the war and infrastructure challenges, 83% of the survey respondents expressed interest in expanding brachytherapy techniques and 41% of respondents reported an increase in brachytherapy patient volume. Globally, brachytherapy's use has declined for some cancer types, yet it remains highly relevant for treating prostate, skin, breast, sarcoma and gastrointestinal cancers, as confir","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S26"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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