The current status of brachytherapy in Europe - A GEC-ESTRO Brachy-HERO survey

Clin Transl Radiat Oncol 2024, doi: 10.1016/j.ctro.2024.100883

What was your motivation for initiating this study?

The GEC-ESTRO Brachy-HERO group is an ESTRO working group dedicated to the investigation of the health economics of brachytherapy in Europe. This study was a first investigation, which was intended through the use of a brief survey to gain an overview of the current utilisation of this technology in the region. The survey also served as a means to identify brachytherapy staff who could potentially act as national contacts for future, more elaborate studies. The ten-question survey was open for a few months. In this short period, almost 100 replies were received. The answers to the survey showed interesting demographic tendencies that the group felt were of interest to the ESTRO community. One example was the wide variation in how brachytherapy is organised in different countries.

What were the main challenges during the work?

Despite the simple structure of the survey and the high response rate, there was a large variation in the number of responses per country. We received no responses from ten of the contacted countries, whereas from several countries, we received multiple answers (40 from one country). We had distributed the survey through national radiotherapy societies in the hope that we would receive one or two answers from national brachytherapy experts in each country, but this did not happen. We deduced from the answers that one reason was that some countries had no one with an overview of brachytherapy in that country. Also, multiple responses from some countries varied greatly, and this issue made it impossible to identify clearly, for example, the numbers of brachytherapy centres in some countries. It was, therefore, difficult to derive a reasonable overview of the current uptake.

What are the most important findings of your study?

The large variation in how brachytherapy is organised and utilised among countries was very interesting. Furthermore, the large variation in the answers from countries with limited organisation indicates that the community could benefit greatly from the creation of national or even Europe-wide strategies to coordinate brachytherapy.

The study showed that in most countries, brachytherapy is considered for gynaecological and, in some cases, prostate cancer treatment; however, in other countries, it was used widely, in some of them for >10 indications. This result shows a strong potential for brachytherapy. International sharing of experience would, therefore, help to expand the use of brachytherapy in underusing countries. It is promising that there are quite a number of ongoing phase II and III trials that will improve insight into the possible benefits of brachytherapy.

What are the implications of this research?

This study should raise awareness of the wide variation in access to brachytherapy for patients across Europe and even within countries. A more coordinated effort can help to improve the utilisation of brachytherapy, and to open the door for more clinical trials. Finally, the study has given the GEC-ESTRO Brachy-HERO group a strong basis for further studies on the health economics of brachytherapy.

Jacob G. Johansen

on behalf of the GEC-ESTRO Brachy-HERO working group