Abstract

Alina Sturdza¹, Marianne Stephanides², Jesper Grau Eriksen³, Kim Benstead⁴, Peter Hoskin⁵, Stefanel Vlad⁶, Alexandre Escande⁷, Stefanie Corradini⁸, Stefan Konrad⁹, Henrike Westerveld¹⁰, Luca Tagliaferri¹¹, Dina Najjari¹², Katarzyna Konat-Bąska¹³, Vesna Plesinac Karapandzic¹⁴, Li tee Tan¹⁵, Remi Nout¹⁶, Bradley Peters¹⁰, Kari Tanderup¹⁷, Ina Jürgenliemk-Schulz¹⁸, Mitchel Kamrava¹⁹

¹Medical University of Vienna, Comprehensive Cancer Center Vienna, Department of Radiation Oncology, Vienna, Austria; ²Medical University of Vienna, Department of Statistics, Vienna, Austria; ³Department of Oncology, Aarhus University Hospital, Denmark, Department of Experimental Clinical Oncology, Aarhus, Denmark; ⁴Gloucestershire Oncology Centre, Cheltenham General Hospital, Department of Oncology, Gloucester, United Kingdom; ⁵Mount Vernon Cancer Centre, Northwood, Hertfordshire, Department of Oncology, London, United Kingdom; ⁶Neolife Enayati Medical City, Department of Radiation Oncology, Bucharest, Romania; ⁷Centre Oscar Lambret, Department of Radiation Oncology, Lille, France; ⁸University Hospital, LMU Munich, Department of Radiation Oncology, Munich, Germany; ⁹Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria; ¹⁰Amsterdam University Medical Centers, AMC, Department of Radiation Oncology, Amsterdam, Netherlands Antilles; ¹¹Interventional Oncology Centre (IOC), Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia - Gemelli ART (Advanced Radiation Therapy), Rome, Italy; ¹²Hospital Duran iReynals, Institut Catalàd'Oncologia (ICO), Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Department of Radiation Oncology, Barcelona, Spain; ¹³Wroclaw Comprehensive Cancer Center, Wroclaw Medical University, Department of Oncology, Wroclaw, Poland; ¹⁴Institute for Oncology and Radiology of Serbia, Department of Radiotherapy, Belgrad, Serbia; ¹⁵Cambridge University Hospitals NHS Trust, Department of Oncology, Cambridge, United Kingdom; ¹⁶Erasmus MC, Department of Radiation Oncology, Rotterdam, Netherlands Antilles; ¹⁷Aarhus University Hospital, Department of Oncology, Aarhus, Denmark; ¹⁸University Medical Centre Utrecht, Department of Radiation Oncology, Utrecht, Netherlands Antilles; ¹⁹Cedars Sinai Medical Center, Los Angeles, CA, Department of Radiation Oncology, Los Angeles, USA

Brachytherapy (BT) is a well-established treatment technique that has been used for over 100 years in successfully treating a wide range of cancers. For patients to continue having access to this treatment, residents need to be adequately trained. We  investigated the state of BT training in Europe to better understand barriers to residents feeling comfortable with practicing BT.  

An online 22-question survey was created based on the survey by the American Association of Radiation Oncology Residents from 2017 with questions added that are unique to training in Europe. The survey addressed several BT topics, including site-specific training (prostate, gynecologic, breast, gastro-intestinal and skin), volume of experience, barriers to training, institutional support, and preferences for further training. Responses to individual statements were given on a 1 to 5 Likert-type scale, reflecting strength of opinion. The survey was sent to 1250 residents in two iterations (November 2019 and February 2020).  The answers were divided by junior  and senior years of training (< 4 versus ≥ 4 years of training). Descriptive statistics were used to describe frequencies. 

Residents from a total of 21 European countries participated and 445 responded to the survey (36%).  Among them, 205 (47%) were seniors. The percentage of residents considering that performing BT independently at the end of residency was very or somewhat important was 66% among the juniors, and  49% for the seniors. Exposure to brachytherapy cases during the whole duration of training is variable amongst senior residents with 50% reporting doing > 5 vaginal cylinder cases for postoperative endometrial cancer, 37% > 5 intracavitary cervical cancer cases, and 23% > 5 gynecologic interstitial cases.  Only 20% of senior residents reported performing > 5 prostate cases with 49% having performed none. 

Senior trainees reported the greatest barriers to achieving independence in BT to be lack of appropriate didactic/procedural training from the supervisors (47%), decreased case load (31%) and lack of personal interest (18%). About 68% of all respondents reported their program lacks a formal brachytherapy curriculum and standardized on training assessment.

The majority of residents in Europe, are interested in performing BT after they complete their training, but don’t feel confident they will achieve this goal.  To address this gap, efforts are needed to develop and implement a formal and comprehensive BT curriculum with easy access to trained instructors.