S58
Brachytherapy - Gynaecology
ESTRO 2026
1 Academic Department of Radiation Therapy and Brachytherapy, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France. 2 Methodology Biostatistics Unit, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France Purpose/Objective: Vulvar and vaginal carcinomas are rare tumors often treated surgically. When surgery is not feasible or excessively mutilating, external beam radiotherapy (EBRT) followed by brachytherapy provides a curative option. Two different brachytherapy techniques are available, pulse-dose rate (PDR) and high-dose rate (HDR), but data comparing their safety profiles are limited. Our department recently transitioned from PDR to HDR brachytherapy, for practical and organizational reasons. This study aimed to compare acute toxicities between HDR and PDR brachytherapy for vulvovaginal cancers. Material/Methods: We retrospectively reviewed 53 women treated with image-guided adaptative brachytherapy (IGABT) for vulvar or vaginal cancers at our institution. All patients received EBRT (45 Gy in 25 fractions) with or without weekly cisplatin, followed by either PDR or HDR brachytherapy, depending on treatment period. PDR was delivered between 2014 and 2021 (n = 26) and HDR between 2022 and 2024 (n = 27). Acute toxicities were graded using CTCAE v5.0 within nine months after brachytherapy. Results: Baseline characteristics were balanced between groups (mean age 69 years, ECOG 0-1 in 94%). During HDR period, 63% of the treated lesion were vaginal and 37% were vulvar, whereas during the PDR period, most cases were vaginal tumors (96%) with very few vulvar ones. Overall, acute toxicities were mild. Grade 3 genital toxicity occurred in three HDR patients (11%), all consisting of necrosis successfully managed with hyperbaric oxygen therapy, compared with none after PDR (p = 0.23). All grade 3 toxicities occurred in patients treated for vulvar or lower third vaginal lesions. No grade ≥ 2 urinary or gastrointestinal events were reported. Conclusion: HDR brachytherapy provided a similar acute toxicity profile to PDR, with low rates of severe events. Given its major logistical and radiation protection advantages, HDR appears to be a safe and efficient alternative to PDR for the management of vulvovaginal carcinomas. Keywords: Vulvovaginal cancer, acute toxicity, HDR References: 1. Chargari C et al. Role of radiotherapy in the treatment of primary vaginal cancer: Recommendations of the SFRO, 2025 update. Cancer/Radiothérapie. nov 20252. Nout R et al.
ESTRO/ESGO/SIOPe guidelines for the management of patients with vaginal cancer. Rad. and Oncology. sept 20233. Renard S et al. Transition from pulsed dose rate to high dose rate brachytherapy: Experience of a single centre. Brachytherapy. sept 20254. Merten R et al. Brachytherapy in vaginal cancer for organ preservation: Clinical outcome and safety from a single center experience. Gynecol Oncol. nov 20245. Westerveld H et al. IGABT for Primary Vaginal Cancer: Results of the International Multicenter RetroEMBRAVE Cohort Study. Cancers (Basel). 23 mars 2021 Digital Poster 1938 3D printed applicators for gynecologic tumors: feasibility and dosimetric benefits Helena Barbara Zobec Logar 1,2 , Robert Hudej 3 , Manja Kobav 1 , Barbara Š egedin 1,2 1 Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia. 2 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. 3 Department of Radiophysics, Institute of Oncology Ljubljana, Ljubljana, Slovenia Purpose/Objective: Standard applicators frequently fail to fit individual pelvic geometries, resulting in inadequate target coverage and increased dose to organs at risk (OARs). Freehand needle placement may be suboptimal and geometrically inaccurate, while non-standardized fixation can compromise reproducibility between treatment fractions. Individualized, patient-specific applicators using 3D printing enable tailored geometry and secure fixation, potentially enhancing dosimetric precision and clinical outcomes. This study evaluates the feasibility, accuracy, and dosimetric advantages of individualized applicators in gynecologic brachytherapy to overcome anatomical, technical, and fixation-related challenges of conventional systems. Material/Methods: Patients with locally advanced or recurrent cervical cancer in whom standard intracavitary or combined intracavitary–interstitial applicators were inadequate for optimal target coverage were included in the study. Individualized applicators were designed based on pre-brachytherapy MR imaging data and fabricated using 3D printing with the selective laser sintering (SLS) method to achieve optimal anatomical conformity and needle placement. Image-guided treatment planning was performed according to GEC- ESTRO guidelines, and dose–volume parameters for target volumes and OARs were compared with those obtained using standard or simulated standard applicator plans. The cumulative EQD2 dose constraints were 75 Gy for the bladder and 70 Gy for
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