LATAM Masterclass Launches with Record Attendance and Incredible Momentum

Andrew Farach, MD

The inaugural LATAM Brachytherapy Masterclass made history this month, bringing together an extraordinary 350 attendees from 15 countries across Latin America for a dynamic, fully packed educational program and hands-on workshop. From the moment the doors opened, the energy was unmistakable—brimming with enthusiasm, collaboration, and a shared commitment to advancing brachytherapy and interventional radiation oncology throughout the region.

Participants engaged with a robust program featuring expert-led sessions, case-based learning, and hands-on discussions designed to elevate clinical practice across a broad range of disease sites. Attendees also had the opportunity to connect directly with ABS leadership, including Dr. Juanita Crook, Dr. Andrew Farach, Kayla Kafka-Peterson, Dr. Ramiro Pino and Dr. Alvaro Martinez.

We extend our sincere appreciation to the outstanding organizing team—Dr. David Martinez, Dr. Lina Loiza, and Kayla Kafka-Peterson—whose dedication turned this vision into reality. A special and emphatic acknowledgment goes to Dr. Alvaro Martinez, whose leadership and forward-thinking vision laid the foundation for this first-ever, immensely successful Masterclass.

As we reflect on the success of this inaugural event, the ABS is more committed than ever to deepening collaboration with our colleagues throughout Latin America. We look forward to continuing this partnership with the goal of establishing the LATAM Masterclass as an annual congress, fostering continued growth in brachytherapy and interventional radiation oncology across the Americas.

Clinical Trials & Research Highlights From ASTRO 2025

• Final results from this randomized study in early rectal adenocarcinoma compared EBRT with a contact brachytherapy boost. The contact therapy boost demonstrated significantly higher long‑term organ preservation rates (59% vs. 81%). Ben Dhia S, et al. – OPERA Trial

• Phase III trial in high‑risk prostate cancer evaluating moderate hypofractionation (68 Gy/25 fractions) versus standard fractionation (46 Gy/23 fractions), both followed by HDR brachytherapy boost (15 Gy × 1) with ADT. The HDR boost cohort experienced reduced Grade 1+ and Grade 2+ GI toxicity. Niazi TM, et al. – PCS VI Trial

• A multi‑institutional registry of 484 Stage I endometrioid endometrial cancer patients treated with adjuvant brachytherapy alone found that MMR status was the strongest prognostic factor for locoregional recurrence‑free survival. Hathout L, et al. – Endometrial Cancer Registry Analysis

• Phase III randomized trial of 94 cervical cancer patients receiving brachytherapy as part of chemoradiation. PEG hydrogel placement after EBRT and before brachytherapy increased rectal separation and reduced rectal dose. Yan J, et al. – PEG Hydrogel in Cervical Cancer

Consensus Statements, Guidelines & Technical Reports

• ABS Education Committee Technical Report: A Resident’s Guide to Evaluation of Prostate HDR Brachytherapy Treatment Plans https://pubmed.ncbi.nlm.nih.gov/40316210/

• ABS Education Committee Technical Report: A Resident’s Guide to Evaluation of Prostate LDR Brachytherapy Treatment Plans https://pubmed.ncbi.nlm.nih.gov/41165635/

• ABS Consensus Guidance: Hybrid Intracavitary–Interstitial Brachytherapy for Locally Advanced Cervical Cancer https://pubmed.ncbi.nlm.nih.gov/40447530/

• Evidence‑Based Consensus Statement: HDR Brachytherapy Boost with EBRT for Localized Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/40707306/

• Multi‑Society Practice Parameter: Radioembolization of Liver Malignancies (ACR‑ABS‑ACNM‑ARS‑SIR‑SNMMI) https://pubmed.ncbi.nlm.nih.gov/40899409/

• Multi‑Society Consensus Statement: Minimum Quality Care Standards for Cervical Cancer in Support of WHO Elimination Goals https://pubmed.ncbi.nlm.nih.gov/40947175/

• ABS Consensus Statement: Rectoprostatic Gel Spacer Use https://pubmed.ncbi.nlm.nih.gov/40976759/

Customized Rotte-Y/Ovoids Applicator for Locally Advanced

Cervical Cancer 

Mustafa Basree, DO, MS and Kristin Bradley, MD

University of Wisconsin-Madison

A 38-year-old woman with 1 year history of menometrorrhagia and prior abnormal Pap was found to have FIGO stage IIB moderately-differentiated, HPV-associated, cervical squamous cell carcinoma. Her disease had extensive involvement of the myometrium, parametria, and vagina without nodal involvement (Figures 1A-B). On speculum exam, the cervix was flush with the upper vagina and replaced by friable, irregular, tissue with a visible os. Bimanual exam demonstrated a 5 cm cervical mass with extension to the anterior and left vaginal fornices, and left parametrial extension on rectovaginal exam.

Given the extent of disease, she was recommended and ultimately treated with definitive external-beam radiotherapy (EBRT) and concurrent weekly cisplatin (40 mg/m2 IV) followed by four fractions of high-dose-rate (HDR) cervical brachytherapy. EBRT was delivered to the pelvis and at regional nodes to 45 Gy, followed by HDR brachytherapy, 4 fractions of 7 Gy each to the cervical high-risk clinical tumor volume (HR-CTV), delivered twice-weekly. Serial exams during EBRT showed early response. Repeat pelvic MRI in week 4 confirmed tumor response but with residual disease (Figure 2).

At the time of first brachytherapy, exam under anesthesia demonstrated an irregular cervix without gross exophytic disease. After sounding to 7 cm, a 15-degree MRI/CT-compatible uterine tandem (Elekta, Geneva) was placed under ultrasound guidance with 25 mm semilunar ovoids/colpostats were selected. In anticipating needing to cover disease beyond tandem and ovoids, six interstitial catheters were pre-loaded into the guide tubes which were then attached to the appropriate positions in the ovoids. The ovoids/colpostats/guide tubes/interstitial catheters were advanced into the vaginal fornices, and the colopostats were secured to the tandem to achieve appropriate geometry. A rectal paddle was placed under the ovoids. A locking mechanism was placed. Patient was then imaged with CT in the brachytherapy suite to appropriately advance interstitial catheters in desired positions. Three (2 medial and 1 left lateral posterior) interstitial catheters were advanced 4-5 cm depending on their position. Following confirmation of placement with repeat CT, patient was transferred to MRI scanner where images were obtained, confirming appropriate positioning of the applicators and packing (Figure 3A).

MRI images were then used for brachytherapy planning, and were fused to her CT to assist with catheter reconstruction. The uterus measured approximately 6-6.5 cm left-to-right, with the tandem centered in the uterine cavity (Figures 3B-E). Given this, tandem was likely not going to adequately cover the entirety of residual GTV in the myometrium without excessive hotspots. An individualized plan delivering 7 Gy per fraction was optimized to balance target coverage and normal-tissue sparing, using four channels (tandem x1, ovoids x2, and interstitial needle x1). The rest of the interstitial catheters were not used as they did not improve the plan. Some of the tandem dwell positions were loaded 92 to 130.5 seconds, extending lateral coverage with doses up to 187% of prescription dose (13 Gy). Reasonable coverage was achieved with 91.5% HR-CTV V90% (Table 1).

For the second fraction, due to uterine size and myometrial involvement, a 3 cm Rotte-Y applicator was used instead of a uterine tandem. Interstitial needles were omitted to minimize risk of bleeding and tissue damage, and the fact that there was no significant residual parametrial disease. The dual tandems of the Rotte Y applicator were rotated into position, and secured together, confirmed with ultrasound. Similar to fraction #1, 25 mm MRI/CT-compatible ovoids were selected and assembled onto colpostats. The ovoids/colpostats were advanced into the vaginal fornices, and the 2 tandems of the Rotte Y were centered between the ovoids. The colpostats were secured together with a simple bridge. A rectal paddle was placed under the ovoids. Wet Kerlix gauze packing was placed to help displace the bladder and rectum and to secure the applicators. The Rotte Y applicator and the colpostats were secured together with foam tape. Since Rotte-Y applicator is not MRI-compatible, she underwent high-quality CT to be used for planning and reconstruction, and were fused to the MRI from her fraction to assist with GTV and HR-CTV delineation. This plan proved to be dosimetrically superior with improvement in HR-CTV V90% (91.5% to 97.8%), HR-CTV D90 (6.5 to 7.4 Gy, 13.9%), HR-CTV D98 (5.1 Gy to 6.3 Gy, 23.5%). This was also associated with improvement in bladder (-9%), bowel (-10.9%), and rectal (-1.3%) D2cc, though with increase in sigmoid dose given the anatomy that day (+14.4%).

Given optimal dosimetry and target coverage, customized Rotte-Y/ovoids/colpostats applicator set was used for subsequent fractions. Figures 4A-B summarize fraction by fraction change in target coverage and OAR doses, with specific doses listed in Table 1. She tolerated treatments exceptionally well with no apparent procedural complications.

Conclusion

This case highlights the adaptability of brachytherapy to customize applicator geometry to patient anatomy and disease distribution. We previously reported the first use of this approach in 2014 for a patient with a septate uterus and locally advanced cervical cancer.¹ Although technically more complex than standard intracavitary or interstitial techniques, this method provides a safe, efficient, and effective alternative for challenging anatomic presentations.

References

1.          Platta CS, Wallace C, Gondi V, et al. Cervical brachytherapy technique for locally advanced carcinoma of the cervix in a patient with septate uterus. J Contemp Brachytherapy. 2014;6(1):76-81. doi:10.5114/jcb.2014.40768

Figure 3B-E: HDR-BT Fraction 1 MRI in MIM treatment-planning software

Figure 4A-B: Percentage difference in target coverage (A) and normal-tissue sparing (B) in fractions 2-4 relative to fraction 1

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