ESTRO 38 Abstract book

S1176 ESTRO 38

be considered as a standard of care in the treatment of locally advanced cervical carcinoma EP-2125 High Dose Rate Brachytherapy in Brazil: Demand Estimation and Coverage in Public Healthcare System G.H. Yoshinari 1 , M.P. Alvarenga 1 , H.H. Fernandes 1 , F. Nadur 2 , J. Domingues 2 , H.F. De Oliveira 1 1 Hospital Marcio Cunha, Servico De Radioterapia, IPATINGA, Brazil; 2 Faculdade de Medicina de Itajuba, Graducao em medicina, Itajubá, Brazil Purpose or Objective The Public Healthcare System (SUS) in Brazil allows high dose rate brachytherapy (HDR) for cervical and uterine cancers only. Objective: to characterize and compare the installed capacity and estimate the demand for HDR in the context of the public access. Material and Methods The number of services and HDR insertions is available in the SUS database. The official estimation of incidence for cervical and uterine malignancy by Federative Unit (FU) from 2011 to 2016 in a two-year basis was adjusted for the proportion of patients with HDR indication and the number of HDR insertions covered by SUS. We also compared the estimated demand for HDR inserts with the number of registered services from 2011 to 2016. Results In 2016, forty-five percent of all public radiotherapy services provided HDR, while four FUs did not offer HDR. There is a concentration in offer in the Southeast region (55%) which concentrates 38.6% of Brazil's population. For the year, the estimated demand for HDR insertions in the year was 46,400, but only 32,500 inserts were registered, generating a deficit of 13,900 inserts (coverage of 70%), even though 25% of the population afford private health insurance. Only three FUs met the estimated demand. We observe a tendency of decrease in the incidence of cervical cancer and a slight increase in the incidence of endometrial cancer, with an increment of services offering HDR in the past five years. Overall demand for HDR remained stable for the period. We detected a peak (superior to Median+2SD) of procedures registered in 2013 (40,939) for an expected need of 46,724 inserts, influenced by inserts carried out by only one FU (São Paulo). The cause of the peak of registered procedures carried out in São Paulo in 2013 should be investigated since it appears to be possible to increase the number of procedures without increasing the number of services providing HDR. There were no peaks detected in the estimated demand for HDR nor services offering the procedure in SUS.

Conclusion Besides the consistent increase of services providing HDR in SUS the distribution of services along the country seems inadequate. There is a 30% deficit in the estimated demand coverage for HDR. EP-2126 Cervix cancer treatments with electronic brachytherapy according to the EMBRACE protocol S. Lozares 1 , A. Gandía 1 , J.A. Font-Gómez 1 , D. Villa 1 , A. Mendez 2 , A. Miranda-Burgos 2 , V. Alba-Escorihuela 1 , S. Jiménez-Puertas 1 1 H.U. Miguel Servet, Física y Protección Radiológica, Zaragoza, Spain; 2 H.U. Miguel Servet, Oncología Radioterápica, Zaragoza, Spain Purpose or Objective In this study we present the first cervical cancer cases treated with interstitial electronic brachytherapy (eBT) in our hospital compared to plans made with high dose rate interstitial brachytherapy with Ir192. Material and Methods In our centre, 8 patients with cervical cancer have been treated with the Axxent (Xoft, Inc.) eBT equipment. The planning of all the patients has been carried out with MR image and CT image following the recommendations of the EMBRACE protocol. The dosimetric parameters of the recommended OAR for bladder, rectum and sigma have been evaluated: D2cc, D1cc, D0,1cc. In addition, the V150 and V200 of irradiated tissue are compared for each plan, both eBT and HDR-BT. The mean age of the patients was 59.8 years (27-70) with different tumor stages, all with good response to external radiotherapy and no parametrial involvement. All patients received IMRT with a regimen of 23 sessions of 2 Gy followed by 4 sessions of 7 Gy of eBT performed in two weeks (first two sessions and then another two a week later) following the EMBRACE recommendations. Results The doses in organs at risk for electronic brachytherapy plans were lower than for HDRBT plans. The dose in bladder with electronic brachytherapy was 62.8% of the prescribed dose for D2cc vs. 63.7% for HDRBT Ir 192, for D1cc was 69.7% vs. 70.1% and for D0.1cc was 85.4% vs. 84.9%. In rectum the D2cc was 27% vs. 34.3%, for D1cc was