ESTRO 2024 Congress report

In this lecture for the GEC-ESTRO Iridium-192 Award 2024, I emphasised how important it was to overcome doubt through mentorship, their use of advanced technology and meticulous practice in the field of brachytherapy. At the Amsterdam University Medical Center we have faced quite some challenges, for example using the AMORE procedure (ablative surgery, brachytherapy with the use of the moulage technique and surgical reconstruction) for paediatric patients, which integrated advanced surgical techniques with brachytherapy. Technological innovations, such as the transition to 3D image-guided treatment planning, have significantly improved the precision of the treatments and our understanding of the relation of dose distribution to the target volume and effects on organs at risk.

In 2022, a survey revealed a confidence gap among residents in their performance of brachytherapy compared with other radiotherapy techniques. Insufficient training and education are responsible for this disparity. There is a need for robust training programmes. Initiatives such as the Euro-Brachytherapy curriculum, supported by GEC-ESTRO, are aimed to bridge this gap by providing comprehensive education and practical experience.

Another aspect for which special skills are needed is the making of a treatment plan. Treatment planning involves numerous objectives, making it a time-intensive process.

With artificial intelligence methods that can be used to optimise brachytherapy treatment plans, this work can be simplified. The BRachytherapy via artificially Intelligent GOMEA-Heuristic-based Treatment planning (BRIGHT) algorithm, developed in collaboration with CWI (Research Institute for mathematics & computer sciencein the Netherlands), can quickly generate multiple treatment plans, and this enhances decision-making and reduces uncertainty. This technological integration, along with continuous imaging and precise implantation techniques, ensures a more reliable and effective treatment process.

Brachytherapy should be accessible to all professionals interested in this field. This can be achieved by reducing the skills dependency. It is a science driven by practice and technology, and not an exclusive art form. There is a need for ongoing innovation and collaboration to advance brachytherapy and to improve patient care worldwide, because confidence built on certainty ultimately benefits patients.

At last, I want to express my gratitude to my family, colleagues, and mentors for their support.

Bradley Pieters

Amsterdam University Medical Center / University of Amsterdam, Department of Radiation Oncology

Cancer Center Amsterdam, Cancer Treatment and Quality of Life

Cancer Center Amsterdam, Imaging and Biomarkers