Journal of Contemporary Brachytherapy
eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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3/2025
vol. 17
 
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abstract:
Original paper

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

Sergio Lozares-Cordero
1, 2
,
Víctor González-Pérez
3
,
Marta Sánchez-Casi
1
,
Tomás González-González
1
,
Paula Castillo Peña
1
,
Mireia Pallarés-Ripollés
3
,
Antonio Herreros-Martínez
4
,
Santiago Pellejero-Pellejero
5

  1. Physics and Radiation Protection Department, Miguel Servet University Hospital, Zaragoza, Spain
  2. Department of Microbiology, Pediatrics, Radiology, and Public Health, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
  3. Medical Physics Department, IVO Foundation, affiliated with the Instituto Valenciano de Oncología, Valencia, Spain
  4. Medical Physics Department, Clinic Hospital, Barcelona, Spain
  5. Medical Physics and Radiation Protection Department, University Complex of Navarra, Pamplona, Spain
J Contemp Brachytherapy 2025; 17, 3: 160–167
DOI: https://doi.org/10.5114/jcb.2025.152539
Online publish date: 2025/06/30
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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 D2cc, D1cc, and D0.1cc 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.

keywords:

endometrial cancer, brachytherapy, electronic brachytherapy, economic evaluation, HDR 192Ir, cost-benefit analysis, dosimetric parameters

  
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