PURPOSE:Patients diagnosed with cancer turn to social media to learn about diagnoses and treatments, but there are concerns of bias and misinformation. Information about brachytherapy on social media has not been evaluated for overall quality. The purpose of this paper is to review YouTube videos on brachytherapy and to analyze their content. METHODS AND MATERIALS:YouTube was queried on June 30, 2025 using keywords prostate brachytherapy, cervical brachytherapy, endometrial brachytherapy, vaginal brachytherapy, skin brachytherapy, breast brachytherapy, HDR brachytherapy, and LDR brachytherapy. Videos were ordered by relevance and the top five videos with criteria of length <16 min were independently analyzed by a radiation oncology attending (brachytherapy expert), radiation oncology resident, and undergraduate student. Discordant answers were reviewed by the radiation oncology attending and resident. RESULTS:Forty videos across the eight keywords were reviewed with an average of 18,356 views (range: 36-203,131), 216 likes (range: 0-1900), and 15 comments (range: 0-123). There was fair agreement between the reviewers when looking at bias based on Fleiss' kappa κ = 0.378 (95% CI, 0.197-0.559), p < 0.001, however the radiation oncology attending and resident detected more misinformation and bias in the prostate, skin, HDR, and LDR videos than the undergraduate reviewer using Cochran's q test χ2(2) = 12.29, p = 0.002 and χ2(2) = 20.93, p < 0.001 respectively. CONCLUSION:Prostate and skin brachytherapy videos have greater frequency of misinformation and/or bias in comparison to gynecologic brachytherapy videos that patients may not readily detect. Increased efforts to create complete, accurate, and unbiased content for brachytherapy patients is warranted.

Checklists have been used across many fields as a systematic framework to reduce human error and improve safety. In radiation oncology, the CB-CHOP acronym was previously developed as a tool to aid physicians in assessing the quality of radiation treatment plans for approval. This manuscript updates the acronym for the modern era with the addition of F and S to create FCB-CHOPS: fusion, contours, beams, coverage, heterogeneity, organs at risk, prescription, and dose summation. These 2 additions reflect the evolution and importance of image fusion to aid in the delineation of targets and organs at risk and dose summation to reflect the increased incidence of reirradiation and the need to consider prior treatment courses in the final plan evaluation. Utilization of this and similar checklists is critical in maintaining high-quality and safe radiation oncology treatments.

Background and objective Over the past few years, the complexity of brachytherapy (BT) has increased, and the practice patterns have shifted to distinguish high-volume centers as primary sites for these procedures. As a result, women with locally advanced cervical cancer (LACC) who are treated with external-beam radiotherapy (EBRT) at local centers are now more likely to be referred to higher-volume centers for their final BT boost. The impact of splitting radiotherapy sites on treatment adherence and outcomes is unclear. The purpose of this study was to compare the duration of treatment, recurrence, and survival between patients who received all radiotherapy at one center compared to those with split treatment. Methods A retrospective chart review was completed to identify women with stage IB-IVA cervical cancer treated with definitive radiation therapy (RT), including EBRT and BT between 2018 and 2023. Patients were grouped by location of EBRT, either at the primary institution (PI) or at an outside center. Patients were excluded if they had incomplete radiation therapy data, a missing address/zip code, metastatic disease, or a prior hysterectomy. Variables collected included demographics (age, race, ethnicity, insurance status, or geographic setting), disease and treatment characteristics, comorbidities, distance traveled to the RT sites, treatment duration, and survival status. Recurrence and survival analyses are limited to patients with at least one year of follow-up. Results Of the 66 women included in this study, 24 (36.3%) underwent EBRT at an outside location and were included in the split RT group. There was no significant difference between the two groups regarding age, disease characteristics, or comorbidities. The mean distance traveled to the PI was compared between the two groups and found to be statistically significant (p=0.001, t-test), with patients in the split group traveling a mean of 66.7 miles compared to 39.1 in the PI-only group. Likewise, the distance traveled to the EBRT site was significant, with women in the split group traveling a mean of only 13.6 miles compared to 39.1 (p<0.001, t-test). Of the 42 patients treated exclusively at the PI, 95.2% completed treatment within the recommended 56 days as opposed to 54.2% of the split RT patients (p<0.001, chi-squared test). Additionally, overall survival data were not significant; 80.8% of women in the PI-only group are reported to be alive without disease compared to 90.0% in the split group (p=1.000, chi-squared test). Conclusions In this study, we observed similar outcomes between LACC patients who had split their RT and those who received both EBRT and BT at the same high-volume PI. Yet, women who received RT at the PI exclusively had a shorter median duration of treatment and were more likely to complete treatment within the recommended timeline. Given the known relationship between treatment duration and patient outcomes in LACC, this study highlights the need to address factors that protract treatment duration to reduce potential disparities in care.

PURPOSE:To assess the impact of MLH1 promoter hypermethylation (MLH1ph) on prognosis and define the patterns of recurrence in stage I or II endometroid endometrial cancer (EEC) treated with adjuvant radiation therapy. METHODS AND MATERIALS:In a retrospective, institutional review board-approved, multi-institutional cohort study, 814 patients with stage I or II EEC with known mismatch repair (MMR) status were included. Tumors with MSH2, MSH6, MLH1, or PMS2 mutations were classified as somatic deficient MMR (sdMMR), whereas tumors with epigenetic silencing of the MLH1 promoter were classified as MLH1ph. Recurrence-free survival (RFS) was calculated by the Kaplan-Meier method. Univariate and multivariate analyses (UVA/MVA) were performed via Cox proportional hazards. Statistical analyses were conducted using SPSS version 27. RESULTS:The median age at diagnosis was 65 years (IQR, 58-71), and most patients had grade 2 or 3 disease (59.2%), ≥50% myometrial invasion (56.0%), and absence of lymphovascular space invasion (58%). Vaginal brachytherapy was delivered to 643 (78.1%) patients, and 180 (21.9%) patients received external beam radiation (EBRT) ± vaginal brachytherapy (VBT). MMR was proficient in 550 (67.6%) patients and deficient in 264 (32.4%) patients. Of the patients with dMMR, most patients harbored MLH1ph (n = 171, 66%), and 93 patients (35.2%) had somatic dMMR. Tumor size ≥ 3.8 cm [hazard ratio (HR), 2.2; P = .003], MMR deficient versus proficient (HR, 2.7; P < .001), and EBRT ± VBT versus VBT alone (HR, 1.9; P = .032) were associated with decreased RFS on MVA. On subgroup analysis including patients with dMMR only, patients with MLH1ph had worse RFS compared with patients with sdMMR (HR, 1.9; 95% CI, 1.1-3.6; P = .025). Distant recurrence was the most common recurrence site, regardless of MMR status. Patients with MLH1ph had significantly higher proportion of vaginal (5% vs 0% vs 2%) and pelvic (5.3% vs 3.2% vs 0.5%) recurrences compared with sdMMR and pMMR, respectively (P = .038). CONCLUSIONS:Patients with MLH1ph had worse RFS, which may be attributed in part to a higher proportion of locoregional recurrences compared with the pMMR and sdMMR patients.

INTRODUCTION: Definitive treatment including chemoradiation and brachytherapy for patients diagnosed with locally advanced cervical cancer requires significant multidisciplinary coordination. Our goal was to assess and share gynecologic brachytherapy best practices from high volume brachytherapy centers. METHODS: A survey was sent to 42 centers within the United States and Canada that perform a high volume of complex gynecologic brachytherapy. RESULTS: Responses were collected from 32/42 (76%) institutions. 41% of responding institutions perform > 100 complex brachytherapy procedures per year. Most departments have > 1 brachytherapist and 85% of respondents complete 1-2 complex brachytherapy procedures per day. 91% of surveyed departments have support staff specifically devoted to brachytherapy. Approximately 50% of intracavitary/hybrid procedures are performed in departmental brachytherapy suites. Institutions use MRI (35%), CT (24%) or a combination (24%) for treatment planning. 88% of respondents use sedation for tandem based procedures. Respondents cite high complexity of care, insufficient reimbursement, untimely referrals, shared operative and clinical duties, expensive applicator acquisition and complex scheduling as challenging aspects of providing brachytherapy services. Conversely, respondents cite a dedicated team, departmental brachytherapy suite, well organized coordination of procedures and personnel, anesthesia support, a full range of applicators, image-based planning near the department and supportive administration as integral components in providing brachytherapy. CONCLUSIONS: Most surveyed institutions have > 1 brachytherapist who perform 1-2 procedures per day in a dedicated brachytherapy space with a team that assists with coordination and scheduling efforts. A well supported multidisciplinary team is vital to ensure state of the art brachytherapy which is essential in curing these challenging malignancies. (c) 2024 American Brachytherapy Society. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

PURPOSE:Surgical resection remains the only curative therapy for pancreatic cancer. Unfortunately, many patients have borderline or unresectable disease at diagnosis due to proximity of major abdominal vessels. Neoadjuvant chemotherapy and radiation are used to down-stage, however, there is a risk that there will be a positive/close surgical margin. The CivaSheet is a low-dose-rate (LDR) brachytherapy device placed at the time of surgery to target the area of highest risk of margin positivity. The purpose of this study is to assess the clinical value of brachytherapy in addition to standard-of-care therapy in pancreatic therapy.METHODS AND MATERIALS:Between 2017 and 2022 patients with borderline and locally advanced pancreatic cancer treated with neoadjuvant chemotherapy and radiation followed by surgical resection were included. There were 2 cohorts of patients: (1) Those who had the LDR brachytherapy device placed at the time of surgery and (2) those who did not. Sixteen of 19 (84%) patients who had brachytherapy were enrolled in a prospective clinical trial (NCT02843945). Patients were matched for comorbidities, cancer staging, and treatment details. The primary outcome was progression-free survival (PFS).RESULTS:Thirty-five patients were included in this analysis, 19 in the LDR brachytherapy group and 16 in the comparison cohort. The 2-year PFS was 21% vs. 0% (p = 0.11), 2-year OS was 26% vs. 13% (p = 0.43), and the pancreatic cancer cause-specific survival was 84% vs. 56% (p = 0.13) in favor of the brachytherapy patients.CONCLUSIONS:Use of LDR brachytherapy at the time of resection shows a trend towards improved progression free and overall survival for patients with borderline or locally advanced pancreatic cancer treated with neoadjuvant chemoradiation.

Purpose In recent years, there has been a national decline in applicants to radiation oncology (RO) residencies, partly due to limited exposure to RO during medical school. Student Interest Groups (SIGs) give students early exposure to a variety of specialties. This study investigates the efficacy of a RO-SIG to increase knowledge and interest in the field. Methodology First and second-year medical students attending an RO-SIG event or shadowing experience completed surveys both prior and following participation. Students ranked their interest in oncology, in RO, and their perceived accessibility of mentors in oncology. Questions were rated on a Likert scale from 0 to 5 (5 highest, 0 lowest). The survey included one short response question about the understanding of the role of the RO, which was evaluated qualitatively. Results 44 students (42 M1s, 2 M2s) completed the pre-survey and 18 (41%, 17 M1s, 1 M2) completed the post-survey. Of the 18 matched responses, interest in oncology increased from 3.67 pre-SIG to 3.89 (p = 0.19) and in RO specifically from 3.17 to 3.89 (p < 0.01). The mean perceived accessibility of faculty mentors in oncology increased from 3.18 to 3.72 (p < 0.01). After interacting with the RO-SIG, the short response answers were more detailed in the understanding of the role of RO. Conclusions RO-SIGs can increase interest in RO through early exposure to the field. In a time where RO has seen a decline in student interest, RO-SIGs are an option to increase engagement, develop interest, and form relationships with mentors in pre-clinical years.

This Oncology Scan will cover multiple key studies presented or published recently, which highlight recent advances in gynecologic malignancies, where the need for personalized treatment has never been more apparent.

Dr. Daniel Petereit has funding from Bristol-Myers Squibb, Polo Ralph Lauren and Irving A. Hansen Memorial Foundation, but these are not related to this work. No authors have disclosures directly related to this project.

PURPOSE:The aim of this work was to report the effect of mismatch repair (MMR) status on outcomes of patients with stage I-II endometrioid endometrial adenocarcinoma (EEC) who receive adjuvant radiation therapy. METHODS AND MATERIALS:This is a multi-institutional retrospective cohort study across 11 institutions in North America. Patients with known MMR status and stage I-II EEC status postsurgical staging were included. Overall survival (OS) and recurrence-free survival (RFS) rates were estimated via the Kaplan-Meier method. Univariable and multivariable analyses were performed via Cox proportional hazard models for RFS and OS. Statistical analyses were conducted using SPSS version 27. RESULTS:In total, 744 patients with a median age at diagnosis of 65 years (IQR, 58-71) were included. Most patients were White (69.4%) and had Federation of Obstetrics and Gynecology 2009 stage I (84%) and Federation of Obstetrics and Gynecology grade 1 to 2 (73%). MMR deficiency was reported in 234 patients (31.5%), whereas 510 patients (68.5%) had preserved MMR. External beam radiation therapy with or without vaginal brachytherapy was delivered to 186 patients (25%), whereas 558 patients (75%) received vaginal brachytherapy alone. At a median follow-up of 43.5 months, the estimated crude OS and RFS rates for the entire cohort were 92.5% and 84%, respectively. MMR status was significantly correlated with RFS. RFS was inferior for MMR deficiency compared with preserved MMR (74.3% vs 88.6%, P < .001). However, no difference in OS was seen (90.8% vs 93.2%, P = .5). On multivariable analysis, MMR deficiency status was associated with worse RFS (hazard ratio, 1.86; P = .001) but not OS. CONCLUSIONS:MMR status was independently associated with RFS but not OS in patients with early-stage EEC who were treated with adjuvant radiation therapy. These findings suggest that differential approaches to surveillance and/or treatment based on MMR status could be warranted.

PURPOSE:To investigate whether gynecologic and radiation oncologists document discussions of chemoradiation treatment's gonadotoxicity for patients with cervical cancer and what patient and physician factors make discussions more likely. METHODS AND MATERIALS:Women with LACC treated with definitive CRT between 2009 and 2022 were included. Visit notes with gynecologic and radiation oncologists were reviewed for sexual health discussions. Fertility and premature menopause discussions were only evaluated among premenopausal patients. Variables of interest including demographics and staging were collected. Univariate and multivariate analyses were conducted using Rv4.2.1. RESULTS:A total of 93 women were included (22-91 years old). Most were Stage IIB (32%) or IIIB (34%). Sexual health discussions occurred among 74.2% of patients and did not have a significant relationship with any patient factors. Fertility discussions occurred with 17.5% of the 57 premenopausal patients and were more likely among younger patients (≤31.9, p < 0.001) with fewer children (≤1, p < 0.001). Premature menopause discussions occurred among 73.7% of premenopausal patients and were more likely among younger patients (≤39.0, p = 0.015). CONCLUSIONS:It is promising to see that oncologists are discussing sexual health and premature menopause with most patients. The limited fertility discussions suggest that oncologists are less likely to discuss fertility as women approach the age of menopause or already have children. Involvement of reproductive endocrinologists and psychologists may provide patients with a more comprehensive understanding of long-term quality of life.

PURPOSE:Accurate target delineation is essential when using intensity modulated radiation therapy for intact cervical cancer. In 2011, the Radiation Therapy Oncology Group published a consensus guideline using magnetic resonance imaging (MRI). The current project expands on the previous atlas by including computed tomography (CT)-based contours, contours with MRI and positron emission tomography (PET) registrations, the addition of common and complex scenarios, and incorporating information on simulation and treatment planning techniques. METHODS AND MATERIALS:Twenty-eight experts in gynecologic radiation oncology contoured 3 cases, first on a noncontrast CT simulation scan and then with registered diagnostic scans. The cases included (1) International Federation of Gynecology and Obstetrics (FIGO) IIIC1 with a bulky tumor and vaginal metastasis, (2) FIGO IIB with calcified uterine fibromas, and (3) FIGO IIIC2 with large lymph nodes. The contours on all 6 data sets (3 CT simulations without diagnostic images and 3 with registered images) were analyzed for consistency of delineation using an expectation-maximization algorithm for simultaneous truth and performance level estimation with kappa statistics as a measure of agreement. The contours were reviewed, discussed, and edited in a group meeting prior to finalizing. RESULTS:Contours showed considerable agreement among experts in each of the cases, with kappa statistics from 0.67 to 0.72. For each case, diagnostic PET ± MRI was associated with an increase in volume. The largest increase was the clinical target volume (CTV) primary for case 2, with a 20% increase in volume and a 54% increase in simultaneous truth and performance level estimation volume, which may be due to variance in registration priorities. For the third case, 92.9% increased their CTVs based on the addition of the diagnostic PET scan. The main areas of variance were in determining the superior extent of CTV coverage, coverage of the mesorectum, and simulation and planning protocols. CONCLUSIONS:This study shows the value and the challenges of using coregistered diagnostic imaging, with an average increase in volumes when incorporating MRI and PET.