Montse Ventura

Patterns of care for brachytherapy in Europe: Updated results

OBJECTIVE This descriptive survey evaluated brachytherapy (BT) practices and resources in the European area. This was a follow-up study to the original patterns of care for brachytherapy in Europe (PCBE). MATERIALS AND METHODS A total of 1121 radiotherapy (RT) centres from 41 countries were asked to complete an online questionnaire on BT practices and resources. Countries with fewer than 50% of centres responding were excluded. Participating countries were divided into three groups based on gross domestic product (GDP); group I contained the countries with the highest GDP. RESULTS The response rate was 56% (633/1121 centres) with 30/41 countries (73%) meeting the inclusion criteria. Sixty percent of reporting centres provided brachytherapy. Responding centres treated an average of 138 (±10, 1 SD) patients with BT; in group I, the mean was 110/centre, an increase of 18% from 2002. CT-dosimetry increased to 61% of centres vs. 33% in 2002. HDR (high-dose rate) BT was the most commonly reported technique (65% of centres). Most BT interventions were for gynaecological tumors (59% of all cases), followed by prostate (17%), breast (9%), lung/bronchus (3%), and esophagus tumors(2%). CONCLUSION Gynaecological BT remains the most common application, although both prostate and breast BT have increased. CT-based dosimetry has become increasingly common since 2002. The use of HDR and PDR (pulsed-dose rate) techniques has increased markedly, while both LDR and MDR (medium-dose rate) have declined.

External beam radiotherapy plus high-dose-rate brachytherapy for treatment of locally advanced prostate cancer: The initial experience of the Catalan Institute of Oncology

PURPOSE The objective of this study was to report initial outcomes in patients with locally advanced prostate cancer (CaP) who underwent external beam radiation therapy (EBRT) treatment combined with high-dose-rate brachytherapy (HDR-BT) as a boost. METHODS AND MATERIALS From 2002 to 2007, 114 CaP patients underwent EBRT followed by (192)I HDR-BT. The patients were classified into intermediate- (Group 1) or high- (Group 2) risk groups. The mean total EBRT dose was 60.0Gy (95% confidence interval [CI]: 59.9-60.1) at 2Gy per fraction. After a mean of 20.6 days (95% CI: 18.4-22.8), all the patients received a single-fraction 9-Gy dose of HDR-BT boost. Of the 114 patients in the study, 103 (90.4%) underwent up to 3 years of complete androgen deprivation therapy after diagnosis. RESULTS The mean followup for the entire group was 32.1 months (95% CI: 29.9-34.4). The 4-year biochemical failure-free survival rate was 97.4% and treatment was well-tolerated. CONCLUSIONS Preliminary biochemical control rates after EBRT plus one fraction of 9-Gy HDR-BT are encouraging. This atypical fractionation schedule is cost-effective and reduces patient discomfort and treatment-related risks. More followup is required to confirm these findings.

Patterns of Care for Brachytherapy in Europe: Facilities and resources in brachytherapy in the European area

PURPOSE The objective of the survey was to obtain detailed information on the use of brachytherapy through a web-based questionnaire. The present article describes the resources available in 2002. METHODS AND MATERIALS The European area was divided into three groups: Group I included the 15 original member countries of the European Union plus 4 others according to economic wealth; Group II included the 10 most recent members of the European Union; and Group III included 14 other European countries. A national coordinator was designated for each country with a general coordinator to oversee the project to encourage the participation of every radiotherapy center. RESULTS Three hundred forty-eight (47.2%) of the responding centers provided brachytherapy services and, compared to data from 1997, most showed a significant increase in the mean number of brachytherapy patients per center. The average number of radiation oncologists involved in brachytherapy was similar in the three groups. The average workload estimated in hours per week at the cancer centers was, however, higher in Groups II and III. Most centers had at least one treatment planning system, although in Group I 7.7% of the centers had three or more treatment planning systems. CONCLUSIONS Notable differences in brachytherapy treatment were observed, especially in the workload of radiation oncologists and physicists in Groups II and III, the two groups with largest number of patients. New surveys can provide a detailed analysis of changes over time, a potentially useful tool to eliminate the differences observed.

Patterns of care for brachytherapy in Europe (PC BE) in Spain and Poland: Comparative results

Summary Background Cancer incidence and its mortality depend on a number of factors, including age, socio-economic status and geographic situation, and its incidence is growing around the world [1]. Cancer incidence in Europe is now about 4000 patients per million per year and due to the ageing population a yearly increase of 1–1.5% in cancer cases is estimated in the next two decades [2–4]. Most of the cancer treatments will include external beam radiotherapy or brachytherapy. Brachytherapy has increased its use as a radical or palliative treatment and become more sophisticated with the spread of pulsed dose rate and high dose rate afterloading machines, and the use of new planning systems has additionally improved quality of treatment [5–14] Aim The aim of the present study was to compare two countries (Poland and Spain) and to report the differences in the use of brachytherapy in these countries. For this reason, several characteristics related to brachytherapy were compared. Materials/Methods The data used were collected using a website questionnaire for the year 2002 where every centre that participated in the survey could introduce, change or update the information requested. Hospitals included in the study were those that provided data on brachytherapy, because our objective was to compare the brachytherapy facilities between Poland and Spain. Results Data were available for 22 centres in Poland and 39 centres in Spain that provided brachytherapy in 2002. Spain having more centres that applied brachytherapy (1.0 centre per 1,000,000 inhabitants in Spain vs. 0.6 centre per 1,000,000 inhabitants in Poland), the average number of brachytherapy patients per centre is lower in Spain than in Poland, 137 and 382 respectively. The 5 main tumour sites treated with brachytherapy in Poland were: gynaecological (73.7%), bronchus (13.0%), breast (2.8%), prostate (2.4%) and head and neck (1.6%). In Spain they were: gynaecological (59.7%), breast (15.4%), prostate (12.8%), head and neck (4.2%) and bronchus (1.5%). Statistically significant differences were found in the number of gynaecological, bronchial and breast brachytherapy patients between the countries. Conclusions Although both countries belong to the European Union, there were observed several differences in the use of brachytherapy. We also found some differences in the brachytherapy techniques used in prostate and head and neck cancers.

Patterns of care for brachytherapy in Europe: updated results for Spain

ObjectiveThe aim of this follow-up pattern of care study was to evaluate current clinical practices, staffing and equipment, and to compare these results to a study performed 5 years previously.Materials and methodsThis descriptive, pattern of care study was carried out via an online questionnaire. The survey was sent to a total of 95 cancer care centres in Spain.ResultsSeventy-three centres (76.8%) responded to the survey. More than half (57.5%) of responding centres offered brachytherapy (BT). A mean of 120 patients/centre were treated by BT in 2007. The most common localisations were the endometrium (29.6% of cases), prostate (29.6%), cervix uteri (14.6%), breast (12.6%), head and neck (3.6%) and vagina (2.5%). Other sites accounted for less than 2% of cases each. Most centres that offered BT (33/40=82.5%) were equipped with a dedicated BT operating room. The most commonly reported dosimetric method was CT dosimetry (31 of 40 centres=77.5%), followed by plain film (30/40=75%), ultrasound (26/40=65%), MRI (8/40=20%), in vivo (7/40=17.5%) and PET-CT (5/40=12.5%) dosimetry.ConclusionThe three most common treatment sites (gynaecological, breast and prostate) remain unchanged from 2002, with prostate treatments showing large increase. Advanced dosimetric techniques (MRI, PET-CT and CT-dosimetry) continue to gain adherents. Some centres treat small numbers of patients, a finding that deserves more attention in terms of cost and quality of care. Although BT remains strong in Spain, it could be further strengthened by making modern dosimetric techniques and treatments more widely available.

PATTERNS OF CARE FOR BRACHYTHERAPY IN EUROPE, IN SPAIN AND ITALY: COMPARATIVE RESULTS

Aims and Background The aim of the study was to compare the facilities for brachytherapy in two similar countries, as are Italy and Spain. This survey reports the differences in the use of brachytherapy in these countries. Methods The data regarding brachytherapy was obtained in 2002 by means of a specially designed web site, because Internet allowed the access to the questionnaire in an easy and safe way. In the first edition of the survey, only the countries in which more than 50% of its centers had completed the questionnaire were included. Among these countries there were Italy and Spain. Results Data was available in 127 centers in Italy and 72 centers in Spain, where 35 and 39, respectively, provided brachytherapy. Although both countries had a similar number of radiotherapy patients and the average number of radiotherapy patients per center was similar in both countries (P = 0.29), there were several differences related to brachytherapy. For instance, the mean number of radiation oncologists regularly performing brachytherapy per center was higher in Spain (P = 0.001). There were also differences in the average number of patients per center in the following tumor sites: breast (P <0.001) and gynaecological (P <0.001). In fact, the average number of patients per center who were treated with brachytherapy in these tumor sites was higher in Spain than Italy. Conclusions Although the estimated workload of the radiation oncologists, physicists and radiation technologists was higher in Spain, no statistically significant differences were found in the average number of patients per center for the following tumor sites: bronchus, head and neck, intracoronary, esophagus, prostate, rectum and skin. Several differences in the use of the brachytherapy procedures applied were also found.

Patterns of care study for brachytherapy: results of the questionnaire for the years 2002 and 2007 in The Netherlands.

Purpose The goal of the ESTRO Patterns of Care study for Brachytherapy in Europe (PCBE) 2002 was to develop an aid to analyse brachytherapy practices. A 2nd version of the PCB questionnaire was created for 2007. Data over 2007 were collected at the radiotherapy institutions in The Netherlands and compared with those from 2002. The aim of this study is to describe national brachytherapy practices, to demonstrate trends, and to provide data for rational health care planning. Material and methods Data were collected using a web-based questionnaire. For each centre, a local coordinator, responsible for coordinating the questionnaires and support of the further analysis was assigned. Data from the national cancer incidence registry was used for comparison with the data from the 21 Dutch departments. Results There was a decrease in low-dose rate equipment in parallel to an increase in both pulsed-dose rate and high-dose rate equipment. The use of 3D CT and MR based imaging techniques showed a slow rise. The most common clinical procedures were for prostate, gynaecological, and oesophageal tumours. A large increase (146%) in permanent implant prostate applications using 125I seeds was observed. The numbers of oesophageal and gynaecological treatments remained stable. There is concern on the low numbers of cases treated in some institutions for a few complex treatment sites. For head and neck, anal canal, paediatrics, bladder and eye interventions it ranged from 3-20 patients per year per institution. Conclusions The increase in number of patient treated with brachytherapy is in accordance with the increases in cancer incidence. The percentage of all radiotherapy patients treated with brachytherapy (approximately 5%) remained stable. The survey identified certain trends in resources and techniques, as well as areas of expected improvement and possible gain in clinical outcome. Data reported from this survey can be used for further planning of resources, facilities and concentration of a low-volume specialised and complex treatments.