S3014
Invited Speaker
ESTRO 2026
frameworks, and systematic integration of patient- centred evidence into decision-making processes. Achieving equitable access to brachytherapy is therefore not only a clinical challenge, but also a priority for patients. 5353 Brachytherapy modalities and patient choice: What are we deciding on? Kathrin Hering Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany. Partner Site Leipzig, Comprehensive Cancer Center Central Germany, Leipzig, Germany This presentation, titled *“Brachytherapy Modalities and Patient Choice: What Are We Deciding On?”*, will examine the multifaceted nature of decision-making in contemporary brachytherapy, with particular emphasis on the interplay between clinical evidence and patient-centered considerations. As brachytherapy techniques continue to evolve, clinicians are increasingly confronted with complex choices regarding modality selection, especially in challenging scenarios such as re-irradiation. The talk will begin with a concise overview of the current literature on decision-support tools within brachytherapy and the broader field of radiation oncology. While shared decision-making has gained prominence as a guiding principle in modern oncologic care, existing tools designed to facilitate these processes remain limited in scope and validation. This gap is particularly evident in brachytherapy, where modality selection often depends on nuanced clinical variables and institutional expertise. Subsequently, the presentation will explore specific clinical scenarios, focusing on re-irradiation in breast, prostate, and gynaecological cancers. These contexts exemplify the inherent complexity of therapeutic decision-making, as clinicians must balance competing priorities such as prior dose exposure, toxicity risks, tumour control probability, and technical feasibility. In parallel, patient preferences—including quality of life considerations, treatment burden, and individual risk tolerance—play a critical yet variably integrated role in the final decision. A central theme of the talk will be the identification of key drivers influencing modality selection. Preliminary insights suggest that, despite the increasing emphasis on patient involvement, decisions are frequently shaped by a combination of clinician experience, local practice patterns, and logistical constraints, in addition to available clinical evidence. This raises important questions regarding the consistency, transparency,
Equally important is a thorough understanding of each system’s sensitivity to different types of deviations, including source misplacement, dwell time errors, and applicator reconstruction uncertainties. Looking ahead, the integration of in-vivo dosimetry into brachytherapy practice has the potential to transform treatment verification from manual checks to proactive, real-time quality assurance. Bridging this gap from “now” to “wow” will be key to enhancing treatment safety, reliability, and confidence in brachytherapy delivery. 5351 Patient perspective: Navigating brachytherapy choices Jacqueline Daly Cancer Patients Europe, Cancer Patients Europe, Galway, Ireland Brachytherapy is a highly effective and, in some indications, essential component of radiotherapy; however, access to this treatment remains uneven across Europe, reflecting broader disparities in the implementation of radiotherapy innovation. From a patient perspective, innovation only delivers value when it is accessible in a timely and equitable manner, yet systemic barriers such as differences in infrastructure, workforce capacity, reimbursement, and national priorities continue to determine whether brachytherapy is offered as a treatment option. This presentation explores how patients navigate decision- making around brachytherapy within this complex landscape, drawing on insights from European patient advocacy, community engagement, and multi- stakeholder discussions. Patients consistently report limited awareness of brachytherapy, significant variability in access to specialised centres, and inconsistencies in how treatment options are communicated by healthcare professionals, all of which influence informed decision-making and patient confidence. Importantly, patients define innovation not only through clinical efficacy, but through its impact on quality of life, side effects, and overall treatment burden, often facing difficult trade-offs between effectiveness and toxicity. In this context, patient-reported outcomes and real-world evidence are critical to ensuring that both clinical practice and policy decisions reflect what matters most to patients. These insights highlight a persistent gap between innovation as a technological breakthrough and innovation as a delivered reality; without effective implementation, existing advances risk remaining underutilised and inaccessible. Addressing these challenges requires coordinated action, including investment in radiotherapy infrastructure and workforce, stronger alignment of European policy
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