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. 2025 Jun;17(3):160-167.
doi: 10.5114/jcb.2025.152539. Epub 2025 Jun 30.

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
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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 et al. J Contemp Brachytherapy. 2025 Jun.

Abstract

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: HDR 192Ir; brachytherapy; cost-benefit analysis; dosimetric parameters; economic evaluation; electronic brachytherapy; endometrial cancer.

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Conflict of interest statement

The authors declare no conflict of interest.

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