The decrease in brachytherapy (BT) utilization is an ongoing and worrisome trend in the United States and the world. Patients with locally advanced cervical cancer who undergo BT have some of the highest cure rates compared to patients with other locally advanced solid malignancies. Many cervical cancer patients in the US are medically underserved and are not treated with curative intent due to lack of access to high quality BT centers.[1, 2] Cervical cancer is a major health problem worldwide and is the second leading cause of cancer death among women who live in low middle-income countries (LMICs) where most women are not offered life-saving BT. The data is irrefutable that when BT is inadequately performed or replaced with specialized forms of radiation, cure rates are dramatically compromised. Prostate BT also achieves some of the highest cure rates for early stage disease, and the highest biochemical control rates for those with more advanced stages of prostate cancer when combined with EBRT as demonstrated in the randomized ASCENDE-RT Trial.
Inadequate resident BT case volumes, lack of public awareness, reimbursement, and competing radiation modalities (IMRT and SBRT) are some of the primary reasons patients do not receive BT in the US. [1, 7] From the ARRO (Association of Residents in Radiation Oncology) survey in 2018, only 54% of radiation residents expressed confidence in developing a BT practice.
To address this “brachytherapy crisis”, the American Brachytherapy Society (ABS) has implemented a 10-year strategy called 300 in 10. The goal is to ensure the training of 30 competent brachytherapy teams per year over the next 10 years through a multi-faceted approach including development of a US national brachytherapy curriculum, simulation-based training workshops, short-term focused fellowships at designated ABS certified centers, and competency evaluation by certified ABS experts with future goals of establishing a certification and maintenance of certification programs. In the last 3 years we have made significant progress providing hands-on workshops where we have trained 130 teams in prostate HDR and LDR brachytherapy. From these workshops, about 80% of these teams have implemented prostate brachytherapy within 6 months of the school.
Mentorship is a cornerstone of the 300 in 10 initiative, leading to the development of a new ABS mentorship program: NextGenBrachy. Through NextGenBT, early career radiation oncologists have been paired with experienced brachytherapists and physicists in a mentorship program for ABS members, designed to take place over at least one year.
Because of COVID, The ABS now implemented several virtual education opportunities including our virtual reality training videos, webinars, virtual outreach events (VOEs), NEXTGenBT and in the future, SpotOnBrachy and Grand Rounds in Urology (GRU), to enhance BT education for our specialty, other medical specialties and the general public.
The journal of Nature, recently highlighted role of prostate brachytherapy in the management of prostate cancer including efficacy and the cost effectiveness compared to other treatment modalities, the ongoing “crisis” of decreased BT utilization and the ABS solution of 300 in 10 (Michael Eisenstein: Prostate Cancer: A Declining Art). As brachytherapists, we need to increase the public demand for brachytherapy by informing the general public–particularly on social media. Increasing the the public demand for competent brachytherapists will fuel 300 in 10. ABS just launched a new marketing campaign with Virtual. The emphasis on this campaign will be Brachytherapy: Curing Cancer From Within. Preserving Quality of Life. We live in a world of social media and the time is here to reach out to non-ABS members, both physicians and patients, through innovative approaches. Developing these virtual media platforms will be an essential part of our strategy.
We need a brachytherapy resurgence – similar to what the Seattle Prostate Institute successfully accomplished in the 1990s. Finally, the 300 in 10 initiative has global implications as our goal is to train competent brachytherapists worldwide through the ABS international committee and the International Cancer Expert Corp (ICEC, Dr. C Norman Coleman).
1. Petereit, D.G., et al., Where Have You Gone, Brachytherapy? . Journal of Clinical Oncology, 2015. 33(9): p. 980-982.
2. Petereit, D.G., et al., Increasing access to clinical cancer trials and emerging technologies for minority populations: The Native American project. Journal of Clinical Oncology, 2004. 22(22): p. 4452-4455, PMID: 15542797.
3. Petereit, D.G. and C.N. Coleman, Editorial: "Global Challenges in Radiation Oncology". Frontiers in Oncology, 2015. 5: p. 1-4.
4. Holschneider, C., et al., Brachytherapy: A Critical Component of Primary Radiation Terapy for Cervical Cancer: An Evidence-Based Review by the Society of Gynecologic Oncology (SGO) and the American Brachytherapy Society (ABS). Brachytherapy, 2019. In press: p. 1-20.
5. Grimm, P., et al., Comparative analysis of prostate-specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study Group. BJU International, 2012. 109: p. 22-29.
6. Morris WJ, T.S., Rodda S, Halperin R, Pai H, McKenzie M, Duncan G, Morton G, Hamm J, Murray N, Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy (the ASCENDE-RT Trial): An Analysis of Survival Endpoints for a Randomized Trial Comparing a Low-Dose-Rate Brachytherapy Boost to a Dose-Escalated External Beam Boost for High- and Intermediate-risk Prostate Cancer International Journal of Radiation Oncology Biology Physics, 2017. 98(2): p. 275-285.
7. Holschneider, C., et al., Brachytherapy: A Critical Component of Primary Radiation Terapy for Cervical Cancer: An Evidence-Based Review by the Society of Gynecologic Oncology (SGO) and the American Brachytherapy Society (ABS). In Press.
8. Marcrom, S.R., et al., Brachytherapy Training Survey of Radiation Oncology Residents. International Journal of Radiation Oncology*Biology*Physics, 2018.
9. Frank SJ, Firas Mourtada F, Crook J, Orio PF, Stock RG, Petereit DG, Rossi PJ, Cox BW, MD, Tang C, Kudchadker RJ, Bruno T, Ma J, Sanders J, and Keyes M. The American Brachytherapy Society Prostate Brachytherapy LDR/HDR Simulation Workshops: Hands-on, Step-by-Step Training in the Process of Quality Assurance, Journal of Brachytherapy, Dec 2020.