S171
Brachytherapy - Urology
ESTRO 2026
Digital Poster 3982 Outcomes of Intraoperative Radiotherapy (IORT) in Urologic Oncology: A Single-Center Experience Across Multiple Tumor Entities Sophia L. Bürkle 1,2 , Julia K. Franz 3 , Ruth Himmelsbach 3 , Natalia Volegova-Neher 1,2 , Mark Gainey 4,2 , Jan-Philipp H. Exner 1,2 , Tanja Sprave 1,2 , Constantinos Zamboglou 5,1 , Philipp M. A. Waibel 1,2 , August Sigle 3 , Markus Grabbert 3 , Christian Gratzke 3 , Anca-L. Grosu 1,2 , Cordula A. Jilg 3 , Simon K. B. Spohn 1,2 1 Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany. 2 Partner Site Freiburg, German Cancer Consortium (DKTK), Freiburg, Germany. 3 Department of Urology, University Medical Center Freiburg, Freiburg, Germany. 4 Division of Medical Physics, Department of Radiation Oncology, University Medical Center Freiburg, University of Freiburg, Faculty of Medicine, Freiburg, Germany. 5 German Oncology Center, European University Cyprus, Limassol, Cyprus Purpose/Objective: Intraoperative radiotherapy (IORT) is a component of multimodal therapy strategies for complex and advanced tumors, aiming to maximize tumor control and reduce recurrence rates. Data in urooncology is scarce and limited to small cohorts, as only few centers provide sufficient expertise and the difficulty of conducting randomized trials. Results from a retrospective single-center cohort are reported. Material/Methods: Between 2002 and 2025, 77 IORT cases in urooncological surgery were performed at our institution. Tumorspecific details, perioperative radiotherapy and surgical parameters as well as time to clinical progression (TTCP) and overall survival (OS) were assessed retrospectively. Complications were classified according to Clavien-Dindo (CDC). Results: Our cohort consisted of 74% male and 26% female patients, with a median follow-up time of 38 months (IQR 13–79). Almost half of the cases (48%) were managed in a palliative overall context. The patient population included diverse primary tumor diagnoses. Detailed characteristics of the study population, underlying tumor entities, as well as information on intraoperative radiotherapy (IORT) and surgical procedures, are summarized in Table 1.
remain limited (1, 2). This exploratory analysis compared longitudinal QoL and PSA kinetics between
HDR-BT and SBRT. Material/Methods:
A retrospective study was performed including 252 consecutive patients with low- or intermediate-risk prostate cancer treated at a single institution with HDR-BT (n = 131) or SBRT (n = 121). Androgen deprivation therapy (ADT) was more frequent with SBRT (34%) than HDR-BT (7%). Patient-reported outcomes were collected at baseline, 6 months, and 24 months using the International Prostate Symptom Score (IPSS), the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP), and the International Index of Erectile Function (IIEF-5). PSA was measured at identical timepoints. Two-sample t- tests were used for exploratory comparisons; analyses excluding ADT users were performed to reduce hormonal confounding. Results: Baseline parameters differed between groups. SBRT patients were older (mean 75.7 vs 71.6 years, p < 0.001) and had higher baseline IPSS (8.0 vs 6.2, p = 0.013) and EPIC-CP scores (9.9 vs 7.1, p = 0.001), reflecting selection of less fit candidates for SBRT. At 24 months, HDR-BT demonstrated statistically superior QoL outcomes:– IPSS: 6.0 vs 10.6 (p < 0.001) – EPIC-CP: 9.9 vs 15.2 (p < 0.001) – IIEF-5: 11.4 vs 5.5 (p < 0.001)Mean PSA declined markedly in both groups (baseline 7.2 vs 8.3 ng/ml; 24 m: 0.84 vs 0.37 ng/ml, p = 0.012). In ADT-free patients, PSA at 24 months was comparable (0.73 vs 0.52 ng/ml, p = 0.20). Conclusion: This non-matched retrospective analysis indicates better patient-reported QoL trajectories after HDR-BT compared with SBRT, with equivalent biochemical control in ADT-free patients. Owing to baseline imbalances in age, LUTS, and risk profile, the results should be interpreted cautiously, and further matched and longitudinal analyses are warranted to validate these observations. Keywords: Prostate cancer, Quality of life, PSA kinetics References: 1. Ma TM, Lilleby O, Lilleby WA, Kishan AU. Ablative Radiotherapy in Prostate Cancer: Stereotactic Body Radiotherapy and High Dose Rate Brachytherapy. Cancers (Basel). 2020 Dec 2;12(12):3606. doi: 10.3390/cancers12123606. PMID: 33276562; PMCID: PMC7761604.2. Kissel M, Créhange G, Graff P. Stereotactic Radiation Therapy versus Brachytherapy: Relative Strengths of Two Highly Efficient Options for the Treatment of Localized Prostate Cancer. Cancers (Basel). 2022 Apr 29;14(9):2226. doi: 10.3390/cancers14092226. PMID: 35565355; PMCID: PMC9105931.
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