ESTRO 2025 - Abstract Book

S66

Invited Speaker

ESTRO 2025

Looking ahead, several innovations are shaping the future of prostate radiotherapy. MRI-guided brachytherapy offers superior soft-tissue contrast and real-time dose adaptation, while PSMA PET imaging is enhancing target delineation for both BT and EBRT approaches. Additionally, the integration of intensified androgen deprivation therapy (ADT) and novel systemic agents with radiotherapy is being actively investigated to improve oncological outcomes further. In conclusion, while brachytherapy boost is a well-established technique with robust evidence behind it, EBRT boost in rising as a valid an attractive alternative. Both strategies play a vital role in the management of localized prostate cancer. The choice between them should be individualized based on disease characteristics, patient factors, and institutional expertise. As technology and systemic therapy continue to evolve, future trials will help refine patient selection and further define the optimal role of each boost modality in the modern era. Speaker Abstracts Artificial intelligence in prostate brachytherapy Danique L.J. Barten Radiation Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands Abstract: Background Artificial Intelligence (AI) has led to multiple innovations in prostate brachytherapy, including automated image segmentation, treatment planning, and outcome prediction (Chen et al., 2024; Fionda et al., 2024). These technologies have demonstrated significant potential in improving clinical workflows. However, their integration and efficiency in routine practice remain areas of ongoing evaluation. While many AI applications have been developed to enhance specific steps in the brachytherapy process, it is essential to ask whether they align with the most pressing clinical needs. Instead of primarily focusing on what AI can achieve, we are reaching a new phase: rather than developing AI in isolation, we should first identify the key challenges in (prostate) brachytherapy and determine how AI can be strategically applied to address them. By refining this process, AI solutions can be more impactful and effectively integrated into clinical practice. Current AI Applications and Clinical Implementation AI has been applied across different stages of the prostate brachytherapy workflow, particularly in contouring and treatment planning, with varying degrees of clinical adoption. For example, dose optimization algorithms, despite showing promising results in research settings, have only recently been implemented in a few centers (Barten et al., 2023). While other institutions are exploring alternative intelligent algorithms to further refine treatment planning (Breedveld et al., 2023; Bélanger et al., 2022). Real-time ultrasound processing and needle placement guidance offer potential benefits in procedural accuracy, but further validation and regulatory approval are needed before they can become standard practice (Chen et al., 2024). Similarly, outcome prediction models hold promise for personalized treatment strategies (Fionda et al., 2024); however, their clinical translation remains limited. This is partly due to challenges in integrating these models into routine decision-making, as their predictive capabilities must align with existing clinical protocols, physician expertise, and patient-specific factors. Without seamless integration, even highly accurate models may not translate into meaningful clinical improvements. In parallel, non-AI-driven technologies, such as improved imaging modalities, intraoperative navigation systems, and patient-specific brachytherapy applicators, are also advancing the field and should be considered alongside AI-based solutions. A New Perspective Rather than further developing AI solutions and then exploring their clinical relevance, the focus should shift to identifying the most pressing challenges in (prostate) brachytherapy and—if not present yet—designing AI 4751