ESTRO 2025 - Abstract Book

S270

Brachytherapy - Gynaecology

ESTRO 2025

resource and cost investments, the implications of which remain unexplored in resource-constrained environments. This study aims to evaluate existing brachytherapy workflows and assess the feasibility of transitioning to IGBT at 14 nationally representative cancer centres in resource-limited settings Material/Methods: This prospective workflow mapping study collected patient process data from participating centres from December 2022 to March 2023, through previously used data collection forms, used in a similar Indian study( 4 ). Centre-specific data regarding infrastructure, treatment workflows employed [(A) 2D X-ray point-A-based intracavitary, (B) 3D CT/MRI volume-based intracavitary, and (C) 3D CT/MRI volume-based intracavitary ± interstitial)], time expenditure, resource availability, and patient throughput were collected. Brachytherapy-related factors influencing workflow time, such as anaesthesia type and planning methodology, were examined. Recommendations for efficient strategies to meet current brachytherapy demand and/or transition to IGBT, considering local resources, were formulated. Results: The study included 365 patient treatment workflows from 14 centres, with Workflow B being the most commonly used. The average time taken for workflows A, B and C were 02:17 (SD ± 00:45), 02:46 (SD ± 01:12) and 04:40 hrs (SD ± 01:15), respectively. Transitioning from Workflow A to B required an additional 00:29 (range: 01:59) while transitioning from B to C required 01:54 (range: 01:52) (Table 1). When no anaesthesia/sedation was used, treatment times for workflows A and B reduced by 32 minutes (95% CI -00:40 – -00:24) compared to treatments that utilized other anesthesia types. The per-brachytherapy machine demand ranged from 0.2 to 9.5. Four countries exhibited low demand (<0.5), two had moderate demand (0.5-1.0), and eight demonstrated high demand (>1.0) (Figure 1). For countries with per-brachytherapy machine demands of less than 1.0, transitioning to advanced IGBT workflows was recommended. Countries facing high additional per-BT unit demand (between 1.0 to 1.5) were recommended the workflow modification of implementing single implant multiple fractions delivery, aimed at meeting existing brachytherapy demand while gradually integrating IGBT. In countries with significantly high additional demand (exceeding 2.0), the priority remained on strengthening existing workflows through financial investment and staff training Conclusion: The findings highlight the brachytherapy practice patterns across resource-limited centres. Implementing context based and time-efficient solutions may help these centres meet brachytherapy demands and facilitate the transition to IGBT workflows. Keywords: image-guide BT, workflow, Resource limited References: 1. R. Atun et al, Expanding Global access to radiotherapy. Lancet Oncol 16, 1153-1186 2. R. Potter et al, MRI -guided adaptive brachytherapy in local advanced cervical cancer (EMRACE-1) ; a multicentre prospective cohort study. Lancet Oncology 22, 538-547(2021) 3. V.Hande et,al., Point A vs. volume based brachytherapy for treatment of cervical cancer: A meta analysis. Radiotherapy Oncol 170, 70-78 (2022) 4. V. Hande et al., Transitioning India to advanced image-based adaptive brachytherapy: A national impact analysis of upgrading National Cancer Grid cervix cancer guidelines. Lancet Reg Health Southeast Asia , 100218(2023)