ESTRO 2024 - Abstract Book

S244

Brachytherapy - Gynaecology

ESTRO 2024

Results:

The live 2.5-day gynecological brachytherapy teaching course in Mumbai was conducted in December 2022 with a total of 39 participants (30 RO, 9 MP). Participants and faculty represented 4 continents (Asia, Europe, Australia/Oceania, Africa) and 11 countries. Thirty-seven participants (95%) replied to the pre-course survey. Overall, 40% of attendees practiced brachytherapy for more than 5 years, with a majority working in high-volume centers. However, only 7% of RO felt fully confident with IC/IS BT applications in LACC, whereas only 1 (11%) MP was fully confident with IC/IS plan optimization. Of the registered participants, 70% of RO and 100% of MP completed the pre-course online homework. On evaluation of homework contours, it was observed that 42.8% of participants overcontoured the GTV whereas undercontouring was observed in 28.5%, and only 28.5% had optimal contouring of GTV (deviation from master contours -7 to +16 cc). For HRCTV the trend was more towards overcontouring (38% participants, deviation from master contours -20 to +14 cc), in a small proportion of participants the HRCTV contour was considered suboptimal due to omission of normal looking cervix. For IRCTV overcontouring was common with deviation ranging from -20 to +100 cc when compared to the master contour. Treatment planning by MP was also evaluated. Participants managed to meet the dose objectives, however, in a vast majority of cases this was done through violation of TP principles (7/9 MP). This was associated with reducing the intrauterine contribution (n=4; 19-29%), reducing ring loading (n=5; 11-21%), or overloading of interstitial needles (n=5; 37-66%) more than the permissible limits. Thirty-six participants (92%) replied to the post-course questionnaire. The participants rated the training course very high: 9.0 on a scale from 1 to 10 with 78% of the participants stating that their expectations were fully met. Participants suggested to extend the hands-on training duration (17%), as that could further increase their confidence levels. At 6 months after the live course a further follow-up survey was performed to which only 10/30 RO (33%) and 1/9 MP (11%) responded. Amongst the responding RO, 70% reported that after attending the course their clinical practice changed, 40% were able to implement concepts of image-based BT in their clinical practice, and 50% increased confidence doing image-guided procedures. Overall, 45% of respondent sites could strengthen IC/IS programme, other sites could not do so due to lack of access to advanced BT applicators.

Conclusion:

We successfully implemented the hybrid concept of gynecological brachytherapy training. Forty percent of responded radiation oncologists did the transition to the image-guided brachytherapy in 6 months after the course. We identified potential areas for improvement: extend the hands-on training duration and increase engagement level of the participants after the training course.

Keywords: education, cervical cancer, hands-on

References:

1. Sturdza A, Stephanides M, Jurgenliemk-Schulz I, et al. Brachytherapy training survey among radiation oncology residents in Europe. Radiother Oncol 2022; 177:172-178.

2. Mittal P, Chopra S, Kamrava M, et al. Brachytherapy training in India: Results from the GEC-ESTRO-India survey. Brachytherapy 2023; 22(4):562-569.