A brief summary of the Brachy-HERO Working Group Meeting held at GEC-ESTRO 2023 in Prague

16-17 November 2023, Prague, Czech Republic

At the GEC-ESTRO meeting 2023 that was held at the Marriott Hotel in Prague, Czech Republic, all working groups were able to present the subjects of their work. The brachytherapy health economics in radiation oncology-(HERO) group held three lectures: “Brachytherapy in Europe – an update” by Professor Peter Niehoff (Cologne, Germany); “Education: the brachytherapy curriculum” led by Dr Alina Sturdza (Vienna, Austria); and “Brachytherapy and climate”, given by Katie Lichter (California, USA) as a remote presentation.

I wish to go into a little bit of detail regarding one of these lectures: “Brachytherapy in Europe – an update“ by Prof Niehoff. This presentation showed the results of a 2023 survey that was dedicated to gaining a good impression of what countries apply brachytherapy in how many centres and for which indications. First of all, Prof Niehoff showed the main conclusions of a comparable survey that was conducted in 2022, stating that the main issue in 2022 had been an inability to reach all countries that had been aimed for. This has happened mainly because there is a lack of a central person who is responsible for brachytherapy in some countries. The 2023 survey comprised 11 questions, which sought to discover which people were responsible for brachytherapy, what kind of machines were used and how many per country, for which indications brachytherapy was used, what indications were considered suitable for brachytherapy treatment in the future and what trials were ongoing.

This year, there had been more replies from all over Europe, but the quality of replies varied hugely between countries. The responses are to be handled with care. For example, even though some German centres replied to the survey, the total number of centres in that country remains unknown due to the lack of central information.

Concerning the dose rate that is used, the survey showed that nearly all centres used a high-dose-rate afterloader, roughly 60% used low-dose-rate implants and around 35% could use a pulsed-dose-rate afterloader. Regarding the most common indications in 2023 per country, gynaecological tumours took the lead; they were treated through brachytherapy in all 26 countries that replied. This was followed by prostate (77-88%), skin (31-58%), eye (31-54%) and breast (35-42%) tumours. The treatment was also used in salvage radiotherapy (31-50%).

Regarding future indications, there was an estimated decline in its use to treat gynae (92.5%), prostate (65%) and eye tumours (20%). There was an estimated increase in the use of brachytherapy to treat skin tumours (45%), for salvage radiotherapy (37.5%) and to treat gastrointestinal tumours (expected to increase to 17.5% from 15% formerly). Indications in breast cancer were expected to remain stable.

In conclusion, Prof Niehoff stated that the use of brachytherapy was very dependent on the country and that even within one country there were big variations, which made it difficult to gather data for a reliable overview. There is a need to create national registries or to identify those that exist, and to have a contact person who is responsible for gathering brachytherapy data in their country. The aim is to gain a good insight into the total number of centres, the number of machines used and the number and type of sites treated through the use of brachytherapy.

Lars Knauth

Sana Klinikum Offenbach

Offenbach, Germany