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abstract:
Review paper
Polish Brachytherapy Society clinical recommendations and expert consensus on radical high-dose-rate brachytherapy for prostate cancer
Natalia Samołyk-Kogaczewska
5
,
Wojciech Burchardt
1, 2
,
Anna Szmigiel-Trzcińska
9
,
Katarzyna Konat-Bąska
11, 12
,
Magdalena Stankiewicz
6
,
- Brachytherapy Department, Greater Poland Cancer Centre, Poznań, Poland
- Electroradiology Department, Poznan University of Medical Sciences, Poznań, Poland
- Faculty of Medicine & Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
- Radiotherapy Centre Amethyst, Rydygier Memorial Hospital, Kraków, Poland
- Department of Radiotherapy, Affidea NU-MED Cancer Diagnostics and Therapy Centre, Zamość, Poland
- Brachytherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
- Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
- Brachytherapy Department, Subcarpathian Cancer Center, Brzozów, Poland
- Radiotherapy Department, Bialystok Oncology Center, Białystok, Poland
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, Kraków, Poland
- Department of Oncology, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
- Radiotherapy Department, Lower Silesian Oncology, Pulmonology and Hematology Center, Wrocław, Poland
- Radiotherapy Department, Affidea International Oncology Center, Koszalin, Poland
- Department of Radiotherapy and Gynecological Oncology, Greater Poland Cancer Centre, Poznan, Poland
J Contemp Brachytherapy 2026
Online publish date: 2026/03/30
Purpose
High-dose-rate brachytherapy (HDR-BT) is an established and highly effective modality for the radical treatment of localized prostate cancer. Despite its widespread use in Poland, relevant aspects of patient selection, treatment qualification, dose and fractionation, integration with external beam radiotherapy (EBRT), and target and organ-at-risk definition vary between centers. The aim of this document was to develop national recommendations and expert consensus statements to standardize the use of radical HDR-BT for prostate cancer.
Material and methods
The Polish Brachytherapy Society convened a multidisciplinary panel of radiation oncologists with extensive experience in prostate brachytherapy. Recommendations were developed through a structured literature review focusing on prospective trials, meta-analyses, and large retrospective studies. Evidence quality and strength of recommendations were assessed using the GRADE framework. A modified two-round Delphi process was applied, involving a core expert panel and an extended national panel. Consensus was predefined as ≥ 75% agreement.
Results
Consensus recommendations were formulated across the entire HDR-BT treatment pathway, including patient assessment, diagnostic work-up, risk stratification, indications for HDR-BT monotherapy and HDR-BT boost combined with EBRT, dose and fractionation schedules, use and duration of androgen deprivation therapy, timing of HDR-BT relative to EBRT, and target volume delineation with organ-at-risk dose constraints. The consensus supports fractionated HDR-BT monotherapy in selected low- and intermediate-risk clinical scenarios, and confirms the role of HDR-BT boost combined with EBRT as a key component of dose-escalation strategies in high- and very high-risk prostate cancer. An EQD2-based approach to dosimetric constraints was endorsed to enhance treatment safety and consistency.
Conclusions
These recommendations represent the first national expert consensus of the Polish Brachytherapy Society on radical HDR-BT for prostate cancer. They provide a comprehensive, evidence-informed framework to harmonize clinical practice, support decision-making, and improve comparability of outcomes across Polish centers. Regular updates will be required as new clinical evidence emerges.
keywords:
prostate cancer, high-dose-rate brachytherapy, expert consensus
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