S69
Brachytherapy - Gynaecology
ESTRO 2026
arms met ≤ 56-day target.Toxicities: GI ≥ G2 = 18 %, 23 %, 20 %; GU > G1 = 22 %, 25 %, 21 %; hematologic ≥ G2 = 15 %, 17 %, 16 %; no significant mucosal effects. Urinary infection was higher in 6 Gy × 4 (14 %) vs 8 Gy × 3 (8 %).At 12 weeks, CR = 60.3 % overall (A 52 %, B 68 %, C 75 %), correlating with shorter OTT (p < 0.01) and higher EQD2 (p = 0.04). Conclusion: In LMIC centers where 3D-CRT predominates, the 8 Gy × 3 twice-weekly HDR brachytherapy schedule achieves optimal EQD ₂ , OAR safety, and efficiency. It improves response, shortens OTT, and reduces cost with minimal toxicity, providing a practical and cost- effective approach for cervical cancer in resource- limited settings. Keywords: HDR brachy; ca cervix, Fractionation ; OTT, LMIC References: 1.Mahantshetty U, Gudi S, Singh R, Sasidharan A, Sastri S, et al. Indian Brachytherapy Society Guidelines for radiotherapeutic management of cervical cancer with special emphasis on high-dose-rate brachytherapy. J Contemp Brachytherapy. 2019;11(4):293– 306.2.Chadha M, Young S, Patel C, Harrison L, Chen C, et al. Experience using three fractions of 8 Gy HDR brachytherapy once a week following chemoradiation therapy in clinical node-negative cervical cancer. Int J Radiat Oncol Biol Phys. 2016;96(2 Suppl):E295.3.Schönicke T, Kittel C, Jöhl A, et al. Outcomes of MRI-guided adaptive brachytherapy for locally advanced cervical cancer: A single-institution experience. Cancers (Basel). 2024;16(10):3495. Digital Poster 2806 Urethral toxicity related to dose-volume parameters in brachytherapy for gynecological cancer. Evita M. Mentink 1 , Britt W.H. Maasen 1 , Britte G.R. Verhoeven 1 , Marieke J.M. Ploegmakers 2 , Cornelia G. Verhoef 1 1 Radiotherapy, Radboud UMC, Nijmegen, Netherlands. 2 Radiology, Radboud UMC, Nijmegen, Netherlands Purpose/Objective: In September 2024, a pilot study was initiated to investigate a possible dose-response relationship between urethral dose and urethral toxicity. The motivation for this study arose from clinical observations of patients developing urethral complaints following brachytherapy with sometimes significant impact on quality of life. Material/Methods: The 10 patients with the highest posterior inferior border of the symphysis (PIBS-point) dose, who were treated with MRI-guided brachytherapy at
Brachytherapy. 2023;22(3):317-324. doi:10.1016/j.brachy.2022.12.0052. Chuk E, Yu C, Scott AA, et al. Clinical Outcomes of 3 Versus 4 Fractions of Magnetic Resonance Image-Guided Brachytherapy in Cervical Cancer. Int J Radiat Oncol Biol Phys. 2024;0(0). doi:10.1016/j.ijrobp.2024.06.0113. Pötter R, Tanderup K, Kirisits C, et al. The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies. Clin Transl Radiat Oncol. 2018;9:48-60. doi:10.1016/j.ctro.2018.01.001 Optimizing and Evolving HDR Brachytherapy in Resource-Limited Settings for Locally Advanced Cervical Cancer SURIANA SULTANA 1 , Naheed Rukhsana 1 , Morsheda Alam 2 , Abu Kausar 2 , Jannatul Ferdusy Soma 2 , Abdul mazed 2 1 clinical oncology, Delta hospital limited, Dhaka, Bangladesh. 2 Medical physicist, Delta hospital limited, Dhaka, Bangladesh Purpose/Objective: To compare dose adequacy, OAR tolerance, toxicity, and short-term outcomes of three HDR brachytherapy schedules—7 Gy × 3, 6 Gy × 4, and 8 Gy × 3—after concurrent weekly chemoradiation for locally Digital Poster 2610 advanced cervical cancer (LACC), and identify the most feasible option for LMICs.In resource-limited centers, 7 Gy × 3 remains common due to manpower, financial, and scheduling constraints. As most EBRT uses 3D-CRT with limited OAR sparing, achieving adequate EQD ₂ and maintaining OTT ≤ 56 days remains critical for cure. Material/Methods: A pilot study included 90 women equally distributed in 3 arms (FIGO IIB–IVA) treated with concurrent weekly chemoradiation (EBRT 46–50 Gy by 3D-CRT ≈ 70% / VMAT ≈ 30%) followed by HDR-ICBT:Arm A – 7 Gy × 3 (weekly), Arm B – 6 Gy × 4 (twice-weekly), Arm C – 8 Gy × 3 (twice-weekly).CT-based plans were prescribed to GEC-ESTRO HR-CTV, maintaining OAR EQD ₂ limits: rectum ≤ 70 Gy, bladder ≤ 90 Gy, sigmoid ≤ 75 Gy. Endpoints included HR-CTV EQD ₂ ≥ 85 Gy, acute GI/GU/hematologic toxicities (CTCAE v5.0), and 12- week response (RECIST 1.1). BED ₁₀ and EQD ₂ were calculated for the tumor ( α / β = 10 Gy). Results: Median age was 51 years; histology: 88 % squamous, 12 % adenocarcinoma. EQD ₂ ≥ 85 Gy was achieved in 62 % (7 Gy × 3), 68 % (6 Gy × 4), and 93 % (8 Gy × 3) (p < 0.01). Mean OAR D ₂ cc stayed within limits—rectum 68 Gy, bladder 87 Gy, sigmoid 71 Gy.Median OTT: 63, 58, and 52 days for Arms A–C; over 80 % of twice-weekly
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