The 2024 World Congress of Brachytherapy brought together leading experts and innovators from around the world and acted as a dynamic platform to encourage the sharing of the latest advances and the promotion of international collaboration in brachytherapy.

On the first day, a series of contouring workshops were well attended. One specialised gynae workshop was led by esteemed faculty from various institutions, one of whom was Henrike Westerveld from The Netherlands. This workshop provided an in-depth look at the latest best practices in target delineation. The day concluded with an engaging opening reception that set the tone for the collaborative spirit of the conference.

On the second day, the presidential roundtable brought together representatives from leading brachytherapy societies to discuss innovative approaches to increase the use of brachytherapy treatments worldwide. The roundtable featured an all-male panel, and this highlighted an area for improvement in gender diversity. The future of brachytherapy is inclusive, and the contributions of women in this field are important.

There were several key contributions from GEC-ESTRO members, which are detailed in the following paragraphs. In the session "GYN Brachytherapy in the Era of Patient-Specific Medicine", experts such as Remi Nout from The Netherlands discussed the latest research on molecular markers that define different subtypes of uterine cancer. Their implications for prognosis and tailored therapeutic strategies were highlighted.

The integration of immunotherapy with radiotherapy and brachytherapy in the treatment of endometrial cancer was also discussed. The focus was on the immunological effects of combining these treatments and the potential to enhance the efficacy of radiotherapy through modulation of the immune system. Key findings from recent clinical trials and studies were presented; these showed improved responses and potential synergy between immunotherapy agents and radiation.

Another focus was patient-specific gynaecological brachytherapy. Advances in the production of custom implants for brachytherapy, such as non-standard implantswere discussed. The benefits of personalised implant design, such as better dosimetric outcomes and patient comfort, were detailed. The session included case studies and technical insights into the customisation process and emphasised the role of precision and adaptability in modern brachytherapy practices. Finally, the role of automated and customised treatment planning for gynaecological brachytherapy was discussed; its potential to streamline the planning process, reduce human error, and improve treatment accuracy were highlighted.

Another gynae session, which was moderated by Manon Kissel from France, was focused on gynae brachytherapy in clinical trials, with the EMBRACE group as the main focus. Kari Tanderup from Denmark discussed preliminary results from the EMBRACE II trial, which showed significant improvements in dosimetric parameters compared with EMBRACE I. These improvements were observed in the use of both external beam radiotherapy ‑ due to better volume definition, standardised contouring, improved delivery techniques and dosimetry ‑ and brachytherapy, in which more interstitial techniques were used. The results are non-inferior to those of EMBRACE I, but they are preliminary and it is too early to determine whether these dosimetric improvements will lead to better tumour control and reduced long-term toxicity.

Supriya Chopra from India presented the Retro-COSMOS study, which is focused on oligometastatic/oligorecurrent cervical cancer and re-irradiation. This retrospective international registry is currently accruing data, with first observations expected in 2025. The aim is to transition it to a prospective study in 2026. Remi Nout discussed the EMBRAVE trial, which is a prospective, observational, multicentre cohort study that is designed to establish a reference for clinical outcomes with state-of-the-art treatment of vaginal cancer. This study also is currently enrolling participants and is seeking additional centres to join during the rest of 2024.

Results from the trial of the use of short-course adjuvant vaginal cuff brachytherapy in early endometrial cancer (SAVE) were presented by Gita Suneja from the USA. This prospective, multicentre, non-inferiority trial randomised a regimen of two x 11Gy to the surface versus the standard-of-care options (7Gy @ 5mm in three fractions, or 5-5.5Gy @ 0.5mm in four fractions, or 6Gy @ surface in five fractions). Outcomes were focused primarily on quality of life. The study enrolled 108 patients at five centres. With a median follow-up of 28 months, preliminary results indicate that short-course vaginal cuff brachytherapy is non-inferior in short-term patient-reported outcomes and has acceptable rates of acute toxicity with no isolated short-term vaginal recurrences.

The final day was focused on practical applications and future-oriented discussions. Innovative practices and future advances in brachytherapy were discussed. Congratulations to Peter Hoskin for his receipt of the prestigious Marie Curie Award! In conclusion, the 2024 World Congress of Brachytherapy was an exceptional event that fostered global collaboration and knowledge sharing. Participants left with enhanced expertise and new connections, ready to implement innovative practices in their own institutions. The congress not only highlighted the current state of brachytherapy, but also set the stage for future advances to ensure continued excellence in patient care.

Dr Manon Kissel

Radiation oncologist

Head of Brachytherapy unit

Institut Curie

Paris, France

Prof. Dr. med. Stefanie Corradini

Vice-chair, Department of Radiation Oncology, University Hospital, LMU Munich, Germany