Image guided cervical brachytherapy practice patterns: 2023/2024 survey of the American brachytherapy society

BACKGROUND: An update of the 2007 and 2014 surveys of the American Brachytherapy Society (ABS) will elucidate current practice patterns of cervical cancer brachytherapy. METHODS: A 40-question survey was sent to all ABS members in June-July 2023 and February 2024; 167 responses were received, with 140 used for analysis. Results were compared to the 2014 survey using chi-squared testing. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI) for outcomes of interest. RESULTS: Compared to 2014, MRI use for treatment planning of the first brachytherapy fraction increased from 34% to 63% (p < 0.001), prescription to the high-risk clinical target volume (HR-CTV) increased from 52% to 94% (p < 0.001), while Point A prescription decreased from 42% to 16% (p < 0.001). Additionally, procedural guidance with ultrasound significantly increased (79% vs. 32%, p < 0.001) along with the use of interstitial needles (always or nearly always, >80%) (29% vs. 4%, p < 0.001). MRI availability around the time of procedure was the largest challenge to incorporating MRI into brachytherapy treatment planning. Compared to those with MRI access reserved specifically for Radiation Oncology, respondents with shared-access or out-of-department MRI were less likely to obtain treatment planning MRIs for each brachytherapy fraction (22% vs. 75%; aOR 0.10 [95% CI, 0.03–0.30], p < 0.001). CONCLUSION: For cervix cancer brachytherapy there has been significant increase in the use of MRI-based volumetric brachytherapy treatment planning, ultrasound guidance during procedures and the addition of interstitial needles. These advancements in practice patterns are congruent with published consensus guidelines and ongoing training initiatives. However, MRI access and lack of easy availability continue to be significant challenges for optimizing cervix brachytherapy.