From Patient Selection to Follow-up: A Practical Approach to Interstitial Brachytherapy for Gynecological Malignancies

Abstract (English)

Interstitial brachytherapy (ISBT) remains an essential component of the treatment of selected primary and recurrent gynecological malignancies, particularly when adequate target coverage cannot be achieved with intracavitary techniques alone. Despite its clinical relevance, successful implementation requires close integration of patient selection, procedural expertise, imaging, treatment planning, and perioperative care.
This educational session will provide a practical, step-by-step approach to gynecological ISBT, covering the complete workflow from patient preparation to post-treatment follow-up. Pre-procedural assessment will include appropriate patient selection, review of previous treatments and imaging, bowel and bladder preparation, antibiotic and thromboprophylaxis strategies, and considerations regarding anesthesia.
The technical procedure will focus on applicator selection and implantation strategies, with particular attention to needle geometry, depth and direction of insertion, and methods to minimize procedural complications. The role of real-time transrectal ultrasound (TRUS) guidance will be discussed as a valuable tool to improve implantation accuracy and reduce the risk of injury to adjacent organs.
Image-guided treatment planning will be addressed, including CT- and MRI-based workflows, target and organ-at-risk delineation, and integration of the implanted geometry with pre-treatment imaging. Practical aspects of MRI acquisition with the applicator in place, contouring, dose prescription, plan optimization and evaluation of target coverage and organ-at-risk constraints will be reviewed.
Potential acute and late complications, including bleeding, infection, urinary or gastrointestinal injury, and procedure-related pain, will be discussed together with preventive measures and their management. Finally, recommendations for applicator removal, immediate post-procedural care, and clinical and imaging follow-up will be presented.
The aim of this session is to provide a reproducible framework for performing gynecological interstitial brachytherapy safely and effectively, highlighting practical tips and common pitfalls that can facilitate implementation and improve treatment quality in daily clinical practice.