A comparative cost-benefit analysis of electronic brachytherapy vs. high-dose-rate iridium-192 for exclusive vaginal cuff treatment in post-operative endometrial cancer.

Abstract

Purpose: To compare the economic and dosimetric aspects of electronic brachytherapy (eBT) and high-dose-rate (HDR) iridium-192 (¹⁹²Ir) brachytherapy for exclusive vaginal cuff treatment in post-operative endometrial cancer patients.

Material and methods: This retrospective observational study was conducted among 115 patients treated with eBT and 70 patients treated with HDR ¹⁹²Ir between 2019 and 2023 at two institutions. All patients underwent 3 fractions of 7 Gy prescribed to a uniform target volume. Dosimetric parameters, including D₉₀, V₁₅₀, and V₂₀₀ for high-risk clinical target volume (HR-CTV) as well as D_2cc, D_1cc, and D_0.1cc for organs at risk (OARs), such as bladder, rectum, and sigmoid colon, were compared. Economic analysis focused solely on cost differences related to source replacement and maintenance, as all other procedural factors (i.e., personnel, clinical workflow, and logistics) were identical for both modalities. The cost of bunker was not considered in the analysis.

Results: Dosimetric analysis revealed comparable target volume coverage between eBT and HDR ¹⁹²Ir. The economic evaluation was focused on cost differences and their relative contributions. The relative average cost per patient under these assumptions was 18.4% lower for eBT (€273.9) than for HDR ¹⁹²Ir, based on Spanish pricing, largely due to differences in source-related expenditures.

Conclusions: While ¹⁹²Ir HDR remains the standard in brachytherapy due to its versatility, eBT presents a cost-benefit alternative for exclusive vaginal cuff treatments, particularly in settings where infrastructure limitations restrict isotope-based brachytherapy. These findings support the complementary role of eBT in clinical practice, optimizing resource allocation without compromising dosimetric quality.