Brachytherapy最新文献

{"title":"Optimization of catheter placement for interstitial gynecological brachytherapy with centroidal Voronoi tessellation.","authors":"Jillian Bennett, Cédric Bélanger, Philippe Y Chatigny, Ruiyan Ni, Luc Beaulieu, Alexandra Rink","doi":"10.1016/j.brachy.2026.09.006","DOIUrl":"https://doi.org/10.1016/j.brachy.2026.09.006","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the feasibility of using images taken after placement of the Template and APPlicator (post-TAPP) with a geometry-based catheter placement optimization to generate interstitial implants in locally advanced cervical cancer cases.</p><p><strong>Methods and materials: </strong>A processing pipeline with Centroidal Voronoi Tessellation (CVT)-based catheter optimization was used to retrospectively simulate optimized catheters on post-TAPP imaging from 32 cervix transperinneal interstitial brachytherapy cases using a Syed Neblett template (16 with iterative MR-guidance, 16 without). Treatment plans were generated with CVT-optimized and clinically implanted catheters. Improvement in plan quality and decrease in number of inserted catheters due to catheter optimization were evaluated against cases performed with and without intraoperative MR imaging.</p><p><strong>Results: </strong>Use of CVT resulted in fewer unused catheters (mean reduction of ∼3) compared to the clinical cases performed both with and without MR imaging guidance, without an increase in %V₁₅₀ or %V₂₀₀. In non-MR-guided cases, use of CVT improved the EMBRACE-II limit compliance for D_90% for CTV_HR. This improvement was not observed in MR-guided procedures.</p><p><strong>Conclusion: </strong>This feasibility study suggests that post-TAPP CVT catheter optimization can achieve clinically acceptable dosimetry while limiting unnecessary catheters, showing a qualitative improvement in dosimetry compared to using preBrachy images alone for catheter selection.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Core competencies for plaque brachytherapy in the treatment of uveal melanomas.","authors":"Diandra N Ayala-Peacock, Sheridan Meltsner, Arpita Maniar, Miguel Materin, Junzo Chino","doi":"10.1016/j.brachy.2026.08.001","DOIUrl":"https://doi.org/10.1016/j.brachy.2026.08.001","url":null,"abstract":"<p><p>Plaque brachytherapy for primary uveal melanoma is a coordinated multidisciplinary effort that requires unique understanding of the contributions of each of the team members as well as knowledge of various radionuclide and the published guidelines on dosimetry, plaque construction, and quality assurance guidelines. This statement of training objectives for radiation oncologists serves as an outline for the necessary knowledge and technical skills needed for independent eye plaque brachytherapy practice.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic value of contact X-ray brachytherapy boost for organ preservation in early low rectal cancer: An OPERA-informed Italian cost-utility analysis.","authors":"Fabrizio Sanna, Salvatrice Campoccia","doi":"10.1016/j.brachy.2026.09.001","DOIUrl":"https://doi.org/10.1016/j.brachy.2026.09.001","url":null,"abstract":"<p><strong>Purpose: </strong>The OPERA phase 3 randomized trial showed that contact X-ray brachytherapy (CXB/Papillon) boost improved 3-year organ preservation compared with external-beam radiotherapy (EBRT) boost in operable early low or mid-low rectal cancer. We estimated the economic implications of CXB in an Italian reimbursement-proxy framework.</p><p><strong>Methods and materials: </strong>We developed an OPERA-informed decision-analytic cost-utility and illustrative budget-impact model comparing neoadjuvant chemoradiotherapy plus EBRT boost with neoadjuvant chemoradiotherapy plus CXB boost from an Italian National Health Service perspective. Clinical probabilities were populated from OPERA. Unit costs were derived from Italian DRG proxies and the 2026 Sardinia outpatient tariff catalog, and were interpreted as reimbursement proxies rather than micro-costed hospital or societal costs. The base case assumed established CXB access; program cost, referral, low-volume implementation, and probabilistic sensitivity analyses explored uncertainty.</p><p><strong>Results: </strong>In the 3-year base case, CXB increased organ preservation from 59% to 81% and reduced expected permanent stoma probability from 18.5% to 8.5%. Mean costs were EUR 22,043 for EBRT boost and EUR 20,337 for CXB boost, whereas QALYs were 2.340 and 2.391, respectively. In probabilistic sensitivity analysis, mean incremental cost was EUR -1626, mean incremental QALYs were 0.048, and CXB was dominant in 81.4% of simulations.</p><p><strong>Conclusions: </strong>In OPERA-like patients treated in experienced programs, CXB may be economically attractive compared with EBRT boost. Findings should be interpreted as tariff-proxy, hypothesis-generating estimates requiring local validation of reimbursement, actual program costs, utility values and surveillance capacity.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and early outcomes of external beam radiation therapy with low dose brachytherapy boost in patients with prostate cancer: A single institution experience.","authors":"Zakaria El Kouzi, Michael K Rooney, Adam B Samman, Ramez Kouzy, Seungtaek Choi, Henry Mok, Karen Hoffman, Quynh-Nhu Nguyen, Comron J Hassanzadeh, Chad Tang, Shalin Jyotindra Shah, Sean E McGuire, Lauren Layer Mayo, Yusung Kim, Surendra Prajapati, Sarath Vijayan, Rajat J Kudchadker, Phuoc T Tran, Teresa Lorraine Bruno, Steven Jay Frank, Osama Mohamad","doi":"10.1016/j.brachy.2026.09.002","DOIUrl":"https://doi.org/10.1016/j.brachy.2026.09.002","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the safety and early oncologic outcomes of external beam radiation therapy (EBRT) combined with a low-dose-rate (LDR) brachytherapy boost in patients with intermediate- and high-risk prostate cancer, as contemporary real-world evidence remains limited.</p><p><strong>Methods and materials: </strong>Investigators retrospectively reviewed 307 patients treated at a large tertiary cancer center between 1999 and 2024. Median age was 66 years; 36% had intermediate-risk and 64% had high- or very high-risk disease, and 91% received androgen deprivation therapy. Late gastrointestinal (GI) and genitourinary (GU) toxicities were defined as occurring more than three months after radiation initiation and graded using CTCAE version 5. Biochemical failure was defined using Phoenix criteria. Outcomes were summarized descriptively; Cox regression analyzed overall survival (OS) and biochemical recurrence-free survival (bRFS), while Fine-Gray models evaluated late toxicity with death as a competing risk.</p><p><strong>Results: </strong>At a median follow-up of 4.6 years, 22 patients developed biochemical recurrence. Five-year bRFS was 98% for intermediate-risk disease and 90% for high- or very high-risk disease; OS and bRFS were 92% and 95%, respectively. Grade 3 or higher GU and GI toxicity occurred in 3.2%, and no significant predictors of severe late toxicity were identified.</p><p><strong>Conclusion: </strong>These findings support this approach for appropriately selected patients in routine clinical care.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep learning-assisted needle artifact suppression for enhanced anatomical visualization in prostate high-dose-rate brachytherapy ultrasound imaging.","authors":"Yu Gao, Thomas Niedermayr, Xianjin Dai, Serdar Charyyev, Lei Xing, Hilary Bagshaw, Mark K Buyyounouski","doi":"10.1016/j.brachy.2026.09.004","DOIUrl":"10.1016/j.brachy.2026.09.004","url":null,"abstract":"<p><strong>Purpose: </strong>Implanted needles introduce acoustic artifacts that degrade transrectal ultrasound (TRUS) images during high-dose-rate (HDR) prostate brachytherapy, complicating ultrasound-only contouring. We developed an artificial intelligence (AI) needle eraser to remove needles and associated artifacts and facilitate structure delineation.</p><p><strong>Methods: </strong>TRUS images from 120 patients undergoing HDR prostate brachytherapy were retrospectively collected. Three-dimensional volumes were acquired immediately before and after needle insertion. A Cycle Generative Adversarial Network (CycleGAN) was trained to transform postneedle images into needle-free images. Two physicians independently rated clinical utility for prostate and urethra delineation using a four-point scale (1 = poor; 4 = excellent). Prostate and urethra contours from preneedle and needle-erased images were compared with clinical reference contours using Dice similarity coefficient (DSC).</p><p><strong>Results: </strong>The AI tool suppressed needles and associated artifacts, improving visualization of the prostate and urethral lumen. Mean reader scores were 3.80 ± 0.43 for prostate and 3.75 ± 0.37 for urethra delineation. Compared with preneedle contours, needle-erased contours showed higher agreement with clinical references: prostate DSC increased from 0.91 to 0.93, and urethra DSC increased from 0.70 to 0.89.</p><p><strong>Conclusions: </strong>A CycleGAN-based needle eraser can generate needle-free ultrasound images from postinsertion scans and improve visualization and contour agreement for physician delineation.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reirradiation using brachytherapy for locally recurrent soft tissue sarcoma: A systematic review.","authors":"Ashwin Subramaniam, William Jin, Benjamin Rich, Brooke Crawford, Francis Hornicek, Julie Grossman, Emily Jonczak, Jonathan Trent, Ty K Subhawong, Erik Geiger, Gina D'Amato, Laura Freedman, Gregory Kubicek, H Thomas Temple, Matthew Studenski, Raphael Yechieli, Crystal Seldon Taswell","doi":"10.1016/j.brachy.2026.07.171","DOIUrl":"https://doi.org/10.1016/j.brachy.2026.07.171","url":null,"abstract":"<p><strong>Background and purpose: </strong>Managing locally recurrent soft tissue sarcomas (STS) following prior radiation therapy remains challenging due to the lack of retreatment options and heightened risk of treatment-associated toxicity. Brachytherapy enables delivery of highly localized radiation with rapid dose fall-off and may serve to address these types of tumors. This systematic review evaluates the efficacy and safety of brachytherapy in the management of locally recurrent STS.</p><p><strong>Materials and methods: </strong>A systematic review was conducted, and its findings are reported in accordance with the PRISMA guidelines. PubMed was searched through July 9, 2026, using Medical Subject Heading (MeSH) terms related to recurrent sarcoma, brachytherapy, and reirradiation. Studies were included if they reported local control and/or toxicity outcomes following brachytherapy-based treatment for locally recurrent STS. Case reports, case series with fewer than 5 patients, studies with significant institutional overlap, and studies evaluating retroperitoneal disease were excluded. Two reviewers independently screened studies and extracted data on local control, survival outcomes, and treatment-related toxicity.</p><p><strong>Results: </strong>Seven retrospective studies met inclusion criteria. Five-year local control rates ranged from 18% to 87%, with better outcomes generally associated with multimodality therapy, smaller tumor burden, and fewer prior recurrences. Overall survival varied across cohorts and was influenced by factors such as tumor grade, recurrence burden, surgical margins, and prior radiation exposure. Grade 3-4 complication rates ranged from 0% to 49%, with higher rates observed in reirradiation settings and cumulative radiation doses approaching or exceeding 100-110 Gy. Emerging approaches, including stereotactic ablative brachytherapy and template-guided placement, demonstrated favorable early safety profiles.</p><p><strong>Conclusion: </strong>Brachytherapy represents a viable salvage strategy for selected patients with locally recurrent STS; however, outcomes remain heterogeneous. Prospective, multi-institutional studies with standardized reporting are needed to better define its role in the re-irradiation setting.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate high-dose-rate brachytherapy with volumetric planning for keloids: Clinical outcomes.","authors":"Jose Antonio Nadal, Enrique López-Jiménez, Cristina Rodriguez, Yasmina Bautista, Isabel de la Fuente, Enrique Cárdenas, Antonio Lozano, Jose Rodriguez, Sergio Cánovas, Juan Antonio Encarnación","doi":"10.1016/j.brachy.2026.07.167","DOIUrl":"https://doi.org/10.1016/j.brachy.2026.07.167","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate clinical outcomes and toxicity of a standardized protocol of immediate (<6 h postoperative) high-dose-rate (HDR) brachytherapy with volumetric planning in patients with keloids.</p><p><strong>Methods and materials: </strong>We conducted a retrospective cohort study including consecutive patients with histologically confirmed keloids treated with surgical excision followed by immediate (<6 h) HDR brachytherapy between April 2014 and November 2025. Treatment was delivered using a uniform fractionation scheme of 12 Gy in three fractions. CT-based planning was performed in all cases, and the clinical target volume (CTV) was defined over the surgical bed. Dosimetric analysis included D90 as the primary coverage parameter. The primary endpoint was local control (LC), defined as recurrence-free interval. Secondary endpoints included late toxicity (RTOG/EORTC) and patient-reported outcomes assessed using the POSAS 3.0 scale.</p><p><strong>Results: </strong>A total of 64 keloids were included. Median follow-up was 37.5 months. The overall local control rate was 92.2%, with five recurrences (7.8%), all occurring within the first 24 months. Median D90 was 98.5%. Larger lesions (>5 cm) showed a higher recurrence rate compared to smaller lesions (12.5% vs. 7.1%). No acute toxicity was observed. Late toxicity was limited to mild hypopigmentation (9.4%), grade one telangiectasia (6.3%), and superficial atrophy (4.7%). One case of mild chondritis (1.5%) was reported. Patient-reported outcomes demonstrated minimal residual symptoms and favorable aesthetic and functional outcomes, as reflected by the patient-reported POSAS scores CONCLUSIONS: Immediate (<6 h) HDR brachytherapy with volumetric planning provides high local control and favorable toxicity in keloid treatment. A regimen of 12 Gy in three fractions is feasible and well-tolerated, representing a valid option in the multidisciplinary management of keloids.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Permanent low-dose-rate seed implantation as single-session partial breast irradiation: Long-term outcomes using a modified institutional protocol.","authors":"Uri Amit, Tyler Meyer, Michael Roumeliotis, Karen Long, Siraj Husain","doi":"10.1016/j.brachy.2026.08.005","DOIUrl":"https://doi.org/10.1016/j.brachy.2026.08.005","url":null,"abstract":"<p><strong>Purpose: </strong>To report long-term oncologic, cosmetic, and toxicity outcomes of permanent breast seed implantation (PBSI) using palladium-103 as accelerated partial breast irradiation (APBI) for early-stage breast cancer.</p><p><strong>Methods and materials: </strong>This prospective, single-institution study enrolled 27 patients in 2013-2015. Our protocol modified the Sunnybrook approach by incorporating general anesthesia, a side-mounted stepper, and immediate postimplant CT verification. Eligibility criteria included age ≥50 years, tumor ≤3 cm, margins ≥2 mm, node-negative invasive or in situ ductal carcinoma, and no lymphovascular invasion. Ultrasound-guided implants were prescribed to deliver 90 Gy to the planning target volume (PTV). Cosmesis (Harvard Scale) and toxicity (CTCAE v3.0) were assessed.</p><p><strong>Results: </strong>At median follow-up of 10.0 years, no local recurrences, distant recurrences, or breast cancer deaths occurred. Overall survival was 96.3% at 5 years and 88.3% at 10 years. Median CTV V100 was 100%, PTV V90 97%, and PTV V100 94%. No Grade ≥3 toxicity occurred. Cosmesis remained excellent or good in ≥90% of evaluable patients through 5 years.</p><p><strong>Conclusions: </strong>This adapted PBSI protocol achieved 10-year local control and breast cancer-specific survival of 100%, with preserved cosmesis and minimal toxicity, supporting PBSI as a safe, effective single-session APBI option for selected patients with favorable early-stage disease.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and clinical evaluation of an automatic verification system for Oncentra brachytherapy treatment planning.","authors":"Jinxin Peng, Jianting Liu, Yongqiang Wang, Ruisong Guo, Zhulin Dong, Xiaofen Xing, Xuegang Chu","doi":"10.1016/j.brachy.2026.08.006","DOIUrl":"https://doi.org/10.1016/j.brachy.2026.08.006","url":null,"abstract":"<p><strong>Purpose: </strong>Current manual workflows for verification of high-dose-rate (HDR) intracavitary and hybrid interstitial brachytherapy are labor-intensive and susceptible to errors. This study developed a fully automated verification system to evaluate plan integrity, quality, and dosimetric accuracy, with the aim of improving patient safety and clinical workflow efficiency.</p><p><strong>Methods and materials: </strong>Featuring an automated verification pipeline for treatment plan integrity and a quality evaluation module, the system assesses key metrics: patient data, treatment parameters, applicator information, the number of CT slices, and volumetric and dosimetric constraints for all volumes of interest (VOIs). Additionally, an independent dose calculation based on the American Association of Physicists in Medicine Task Group No. 43 (TG-43) formalism is incorporated.</p><p><strong>Results: </strong>A total of 79 cases successfully passed the integrity check, and the remaining six triggered system-generated warnings. Quality assessment confirmed that the majority of plans met all clinical constraints, with only minor clinically acceptable deviations observed in isolated cases. A mean Gamma passing rate of 98.70% (3%/2 mm criterion) was obtained in independent plan dose verification, and a positive correlation with the target volume was observed.</p><p><strong>Conclusions: </strong>The implemented automated verification system is proven to be reliable and practical for clinical use. It enhances the efficiency of intracavitary and hybrid interstitial HDR brachytherapy plan quality assurance while effectively mitigating the risks associated with human error.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypofractionated 44 Gy in 20 fractions versus conventional chemoradiation in cervical cancer: 2-year results of the randomized HYPOCx-iRex trial with an exploratory pooled analysis of a single-institute EMBRACE-II cohort.","authors":"Tissana Prasartseree, Pittaya Dankulchai, Wiwatchai Sittiwong, Phattarapol Laolugsanalerd, Sirapob Seksunwiriya, Soponvit Wattanakul, Tewpaithong Rodwong, Peerakarn Charoenwong, Wasawat Jirasuviboon, Nonpawit Suriyanusorn, Akrapol Suppasedtanon, Chayanis Kositamongkol, Pochamana Phisalprapa, Ann H Klopp","doi":"10.1016/j.brachy.2026.08.004","DOIUrl":"https://doi.org/10.1016/j.brachy.2026.08.004","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate 2-year late gastrointestinal (GI) toxicity, oncologic outcomes, and cost-effectiveness of hypofractionated concurrent chemoradiation with 44 Gy in 20 fractions (44 Gy/20F; HYPO) versus conventional fractionation (45 Gy/25F; CVRT + EMB) for locally advanced cervical cancer (LACC).</p><p><strong>Methods: </strong>The primary analysis was the randomized HYPOCx-iRex comparison (HYPO n = 21 vs. CVRT n = 19). A pre-planned pooled analysis additionally incorporated a concurrent, nonrandomized single-institute EMBRACE-II cohort (EMB n = 28; total n = 68). Late GI toxicity was graded by CTCAEv5.0. Dose-toxicity analysis used Cox and Probit regression to identify the effective dose associated with 10% toxicity probability (ED10). The indirect ratio of excess dose volume at 60 Gy EQD2 (iRex60) was evaluated as a brachytherapy (BT) conformity index. Locoregional control (LRC) and overall survival (OS) were estimated by Kaplan-Meier. Incremental cost-effectiveness ratios (ICERs) were calculated from provider and societal perspectives.</p><p><strong>Results: </strong>Median overall treatment time was 39 versus 46 days in HYPO versus CVRT+EMB (p < 0.001). Late GI toxicity was numerically higher in HYPO (2-year Gr ≥2: 23.8% vs. 10.8%, pLR = 0.168; Gr ≥3: 19.1% vs. 5.3%, pLR = 0.066); iRex60 was identified as an independent predictor in multivariable regression (ED10 = 1.6 and 1.85 for Gr ≥2/Gr ≥3; proposed cut-off iRex60 <1.7). Favorable but nonsignificant trends in LRC (95.2% vs. 77.5%; HR = 0.43, pLR = 0.260) and OS (100% vs. 76.8%; HR = 0.22, pLR = 0.107) were observed. The 44Gy/20F regimen demonstrated dominant cost-effectiveness.</p><p><strong>Conclusion: </strong>Hypofractionated chemoradiation achieved LRC and OS comparable to conventional fractionation with shorter treatment time and lower cost. The higher late GI toxicity observed with hypofractionation is clinically meaningful without statistical significance. Further optimization of brachytherapy conformity and low-to-intermediate dose constraints is proposed before clinical adoption. The iRex60 threshold and the cost-effectiveness findings are hypothesis-generating and need further validation.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}