A Message From the President
Welcome to the May 2021 edition of the American Brachytherapy Society's BrachyBlast.

This is an exciting time of the year as we all start preparing our plans for the summer, and I hope you have made the ABS Virtual Meeting part of your plans, we truly have exciting content that might be unique as we hope to go back to normal in-person meeting in 2022 in Denver. I am sure you are feeling a sense of relief since more vaccinations have been administered and the decline of COVID incidence. I am also delighted that the schools have announced going back to a more normal schedule this coming Fall. 

I look forward to seeing you “virtually” at the 2021 ABS Annual Meeting will be designed around the theme Brachytherapy Innovations in a time of Change. Scientific Program Chair Kristen Bradley along with Co-Chair, Timothy Showalter are finalizing the elements, please visit the ABS website for the program schedule. We will also provide many SAMs to ensure you have what you need for 2021, both for physicians and physicists. We will also have a special session on radiopharmaceuticals and the role of brachytherapy to take a leadership role for the novel agents that are on the market today and those pending FDA approval soon. 
 
In May, we also had a successful virtual World Congress which was postponed from last April’s meeting in Vienna. I am sharing below a summary and video for the Marie Curie Medal award session that we presented to Dr. Alvaro Martinez that I wrote with the current chair of GEC-ESTRO, Dr. Jurgenliemk-Schulz.

Dr. Glaser has shared a useful article by Dr. Peter Rossi and colleagues on hydrogel spacers and brachytherapy. This is a great summary of the current implications of the hydrogel application in the setting of brachytherapy. This is still early as further prospective studies are needed. The authors advise adopting best practices, training, and evaluating the risk versus benefits at all times, with all patients
 
Dr. Mitch Kamrava's article “Understanding the financial toxicities of brachytherapy” provides an important consideration as you discuss brachytherapy options with your patient. This is yet another element to optimize “value” for the patient experience. 

Firas Mourtada, Ph.D.
President, ABS

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Hydrogel Spacers and Brachytherapy
Peter Rossi, MD | David Marcus, MD | William Hall, MD | Manuj Agarwal, MD
Overview:
 
The use of brachytherapy for the definitive treatment of localized prostate cancer has been established for over four decades.[1] Therapy may be delivered using either permanent seed low dose rate (LDR) or high dose rate (HDR) technique. Both techniques are recommended in the ASCO/CCO joint guidelines[2], and data suggests comparable oncologic outcomes. Brachytherapy may be used as monotherapy for low risk and selected intermediate-risk patients or in conjunction with external beam radiation therapy (EBRT) for unfavorable intermediate and high-risk patients.
 
Brachytherapy is highly conformal and provides greater sparing of surrounding normal tissues compared to EBRT. However, the anterior rectal wall may be exposed to high doses of radiation given its proximity to the prostate. The rates of ≥ grade 2 rectal complications are low, with a range of 2.2 to 26% (weighted average of 7.9%) and a fistula rate of 0.4 to 3.3%.[3] The risk is increased for men on anticoagulation therapy or with inflammatory bowel disease (IBD).[4] Of the many factors that may predict for rectal injury, the rectal volume exposed to 100 percent of the prescription dose (RV100) and the maximum dose to the 2cc volume (D2cc) most often correlate.[5, 6]
 
In an effort to avoid rectal complications, bio-absorbable hydrogels have been developed. Using a transperineal approach and under ultrasound guidance, a needle is advanced into the retroprostatic fossa, the space between the rectum and Denonviller’s fossa is hydro-dissected, and the hydrogel is injected. When formed, the gel increases the physical distance between the prostate and the rectum by a mean of 11 mm and lasts for three months. Phase III data in the EBRT setting demonstrated a significant dosimetric reduction in rectum constraints, which resulted in a decreased rate of grade 1/2 rectal toxicities and improved long-term patient-reported quality of life.[7]
 
As radioactive exposure from brachytherapy decreases by the inverse square law, hydrogel utilization has the potential to decrease damage to the rectal wall. Hydrogel has been used in both the monotherapy and boost settings, using LDR and HDR technique with a demonstrated decrease in rectal dose, decreased rectal toxicity, and improved quality of life.[8-14] It has also been applied to the salvage setting[15], and to patients with IBD or those on anticoagulation.[16]
 
LDR
 
To date, there have been no prospective trials that have reported on the use of hydrogel rectal spacers in the setting of LDR prostate brachytherapy. However, several groups have published retrospective reports evaluating the impact of these spacers on rectal dosimetry, physician-graded toxicity and target volume coverage.
 
In a study from Memorial Sloan Kettering Cancer Center of patients undergoing definitive Pd-103 prostate brachytherapy, the use of a rectal spacer was associated with significantly improved rectal dosimetry compared to a separate cohort of patients treated without a spacer. Notably, acute rectal toxicity occurred in 9.5% of patients, with none higher than grade 2.[17]
 
In a series from Japan, Morita et al. reported on 100 patients treated with iodine-125 prostate brachytherapy with the placement of a hydrogel rectal spacer. Spacer placement yielded a mean distance of 11.64 mm between the prostate and rectum. Compared to a separate series of 200 patients treated without a spacer, patients treated with a spacer had statistically significantly lower mean rectal V150 and V100 values with no adverse effect on prostate target volume coverage.[18]
 
Kahn et al. reported improvements in rectal dosimetry associated with the use of a hydrogel rectal spacer in 80 consecutive patients undergoing LDR prostate brachytherapy. In patients receiving a spacer, the adjusted mean dose to 1 cc, 2 cc and 5 cc of the rectum was decreased by 32%, 26% and 17% respectively compared to patients treated without a spacer. There were no significant differences in physician-reported rectal toxicities between groups. Analysis of prostate gland target volume coverage also demonstrated no differences between groups.[10]
 
Finally, Nehlsen et al. reviewed dosimetry and quality of life outcomes in 168 patients who underwent LDR prostate brachytherapy boost following prostate IMRT between 2014 and 2019. In patients with a hydrogel spacer, mean prostate-rectum separation was 7.5 mm, and the mean rectal V100 among this group was 47% lower compared to patients without a spacer. Between groups, there were no differences in the proportion of patients with prostate D90 ≥100 Gy and no differences in quality of life.[19]
The above retrospective studies consistently demonstrate a pattern of improved rectal dosimetry with the use of a hydrogel rectal spacer in the setting of LDR prostate brachytherapy. It is unclear if these dosimetric advantages translate into meaningful improvement in rectal toxicity. Importantly, none of these studies demonstrate any detriment in target volume coverage associated with the use of a spacer.
 
HDR
 
Hydrogel spacers have also been studied in the setting of HDR prostate brachytherapy, with favorable results. To date, there have been no prospective trials reported on the use of hydrogel rectal spacers in the setting of HDR prostate brachytherapy. Below is a summary of published retrospective studies evaluating the clinical benefit of hydrogel rectal spacer when utilized with HDR prostate brachytherapy.
 
Strom and Biagioli et al.[12] retrospectively analyzed 200 patients who received 2 fraction HDR brachytherapy with or without external radiotherapy. During the first HDR procedure they injected 10 mL hydrogel and 5 mL with the second implant. The authors demonstrated feasibility, with 100% success rate of implantation. Mean rectal separation at the end of an HDR case was 12 mm with the first HDR implant, and 4 mm with the second. This led to a significantly decreased rectal dose.
 
In a study from UCLA, treatment plans of 18 patients with hydrogel following HDR were compared with 36 patients without. In the 54 plans analyzed, the 2 populations were similar in all regards at baseline; however, in the patients that received hydrogel rectal spacing, there was a consistently lower dose to the rectum for multiple dosimetric endpoints.[20] The authors concluded that the use of hydrogel spacing in the setting of HDR brachytherapy is clinically feasible and also reduces radiation dose to the rectum.
 
In a series from Australia, 32 patients who received hydrogel spacer following HDR prostate brachytherapy were compared to 65 patients who were treated without a spacer. They showed feasibility and consistent separation between the rectum and the prostate with the use of a spacer along with decreased radiation dose to the rectum. Moreover, this reduction in rectal dose corresponded to less acute and late grade 1 GI toxicity in the group treated with a spacer.[8] Hydrogel spacing has also been used successfully in situations of HDR brachytherapy as salvage for radio recurrent disease and in patients with ulcerative colitis.[16, 21]
 
The above studies consistently demonstrate spacing and feasibility, decreased rectal dose, and in the Australian series, improvement in treatment-related toxicity with the use of a hydrogel rectal spacer in the setting of HDR prostate brachytherapy. Furthermore, based on this limited data, the use of a spacer does not appear to compromise target coverage, and the spacers themselves do not seem to confer meaningful toxicity. Nonetheless, further studies are needed, ideally including prospective trials, to more definitively quantify the effect of hydrogel spacers on rectal toxicity in this setting.
 
Sequencing
 
There is no consensus on the ideal sequencing of hydrogel spacer placement and brachytherapy, in part because there are many different clinical practice scenarios. The hydrogel rectal spacer may be placed either by the urologist, radiation oncologist, or, in some cases, the interventional radiologist prior to treatment planning. Hydrogel spacers have generally been utilized in the setting of MRI-based treatment planning, as the spacer can be easily visualized on T2-weighted MRI sequences. More recently, a radiopaque hydrogel rectal spacer is now also available for CT-based planning. In the setting of EBRT, a common practice is to place the hydrogel rectal spacer at the time of gold marker placement, followed a few days later by CT and MR-based simulation.
 
Sequencing with brachytherapy presents a number of reasonable options. If brachytherapy is combined with external radiation, the hydrogel rectal spacer can be placed at the time of gold marker placement prior to MR-based treatment planning for EBRT, or, if brachytherapy is done as monotherapy, at the time of the first LDR or HDR implant.
 
Pitfalls, Cautions, and Potential for Toxicities Associated with Hydrogel Spacer Use
 
Although the above retrospective data appears to support the relative safety of hydrogel spacer use in the setting of LDR and HDR brachytherapy, spacer-related toxicities have been reported in the literature. In a series by Yeh et al., two grade 3 toxicities were reported.[14] One of these is described in the results as a necrotizing fasciitis that occurred at four months following spacer placement, which ultimately required a colostomy. Similarly, in a recent case report, an event of rectal infiltration of hydrogel was not appreciated prior to SBRT, and the patient sustained injury to the rectum with fistula and osteomyelitis that required pelvic exenteration.[22] Additionally, in a database of toxicity events maintained by the FDA titled the Manufacturer and User Facility Device Experience (MAUDE, https://www.accessdata.fda.gov/cdrh_docs/pdf14/DEN140030.pdf), several similar events related to hydrogel spacer placement have been reported.
 
Given the goal of SpaceOAR to purely mitigate toxicity, even a few of these severe events could dramatically impact the risk/benefit considerations associated with SpaceOAR use. If this should be routinely done for brachytherapy patients requires careful consideration and ideally additional prospective investigation. An interventional procedure to cure a malignancy, as compared to an interventional procedure to purely mitigate a grade 2 toxicity event, are very different primary goals and require very different considerations before they are performed.
 
Conclusion
           
The authors’ intent is to summarize the data at this juncture with hydrogel spacing focusing on the use with brachytherapy. It is clear that spacing utilized in the setting of brachytherapy, may reduce early or late gastrointestinal side effects, and does not degrade the quality of the treatment. Although toxicities associated with spacers appear to be rare, clinicians should be aware of potential complications and should be trained on appropriate spacer placement. Further study with prospective evaluation is essential. We advise adopting best practices, training, and evaluating the risk versus benefits at all times, with all patients. 
 
Bibliography
 
1.        Denmeade, S.R. and J.T. Isaacs, A history of prostate cancer treatment. Nat Rev Cancer, 2002. 2(5): p. 389-96.
2.        Chin, J., et al., Brachytherapy for Patients With Prostate Cancer: American Society of Clinical Oncology/Cancer Care Ontario Joint Guideline Update. J Clin Oncol, 2017. 35(15): p. 1737-1743.
3.        Schutzer, M.E., et al., A review of rectal toxicity following permanent low dose-rate prostate brachytherapy and the potential value of biodegradable rectal spacers. Prostate Cancer Prostatic Dis, 2015. 18(2): p. 96-103.
4.        Peters, C.A., et al., Low-dose rate prostate brachytherapy is well tolerated in patients with a history of inflammatory bowel disease. Int J Radiat Oncol Biol Phys, 2006. 66(2): p. 424-9.
5.        Price, J.G., N.N. Stone, and R.G. Stock, Predictive factors and management of rectal bleeding side effects following prostate cancer brachytherapy. Int J Radiat Oncol Biol Phys, 2013. 86(5): p. 842-7.
6.        Mendez, L.C. and G.C. Morton, High dose-rate brachytherapy in the treatment of prostate cancer. Transl Androl Urol, 2018. 7(3): p. 357-370.
7.        Mariados, N., et al., Hydrogel Spacer Prospective Multicenter Randomized Controlled Pivotal Trial: Dosimetric and Clinical Effects of Perirectal Spacer Application in Men Undergoing Prostate Image Guided Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys, 2015. 92(5): p. 971-977.
8.        Chao, M., et al., Improving rectal dosimetry for patients with intermediate and high-risk prostate cancer undergoing combined high-dose-rate brachytherapy and external beam radiotherapy with hydrogel space. J Contemp Brachytherapy, 2019. 11(1): p. 8-13.
9.        Heikkila, V.P., A. Karna, and M.H. Vaarala, DuraSeal as a spacer to reduce rectal doses in low-dose rate brachytherapy for prostate cancer. Radiother Oncol, 2014. 112(2): p. 233-6.
10.      Kahn, J., et al., Rectal spacing, prostate coverage, and periprocedural outcomes after hydrogel spacer injection during low-dose-rate brachytherapy implantation. Brachytherapy, 2020. 19(2): p. 228-233.
11.      Patel, A.K., et al., Acute patient-reported bowel quality of life and rectal bleeding with the combination of prostate external beam radiation, low-dose-rate brachytherapy boost, and SpaceOAR. Brachytherapy, 2020. 19(4): p. 477-483.
12.      Strom, T.J., et al., A dosimetric study of polyethylene glycol hydrogel in 200 prostate cancer patients treated with high-dose rate brachytherapy+/-intensity modulated radiation therapy. Radiother Oncol, 2014. 111(1): p. 126-31.
13.      Vaggers, S., et al., Polyethylene glycol-based hydrogel rectal spacers for prostate brachytherapy: a systematic review with a focus on technique. World J Urol, 2020.
14.      Yeh, J., et al., Polyethylene glycol hydrogel rectal spacer implantation in patients with prostate cancer undergoing combination high-dose-rate brachytherapy and external beam radiotherapy. Brachytherapy, 2016. 15(3): p. 283-287.
15.      Mahal, B.A., et al., Use of a rectal spacer with low-dose-rate brachytherapy for treatment of prostate cancer in previously irradiated patients: Initial experience and short-term results. Brachytherapy, 2014. 13(5): p. 442-9.
16.      Trager, M., et al., SpaceOAR to improve dosimetric outcomes for monotherapy high-dose-rate prostate implantation in a patient with ulcerative colitis. J Contemp Brachytherapy, 2018. 10(6): p. 577-582.
17.      Taggar, A.S., et al., Placement of an absorbable rectal hydrogel spacer in patients undergoing low-dose-rate brachytherapy with palladium-103. Brachytherapy, 2018. 17(2): p. 251-258.
18.      Morita, M., et al., Placement of SpaceOAR hydrogel spacer for prostate cancer patients treated with iodine-125 low-dose-rate brachytherapy. Int J Urol, 2020. 27(1): p. 60-66.
19.      Nehlsen, A.D., et al., The impact of a rectal hydrogel spacer on dosimetric and toxicity outcomes among patients undergoing combination therapy with external beam radiotherapy and low-dose-rate brachytherapy. Brachytherapy, 2021. 20(2): p. 296-301.
20.      Wu, S.Y., et al., Improved rectal dosimetry with the use of SpaceOAR during high-dose-rate brachytherapy. Brachytherapy, 2018. 17(2): p. 259-264.
21.      Hepp, R., et al., Salvage high-dose-rate brachytherapy for prostate cancer persistence after brachytherapy: repeated use of a polyethylene glycol hydrogel spacer. J Contemp Brachytherapy, 2018. 10(2): p. 169-173.
22.      Mclaughlin MF, F.M., Timmerman RD, Hudak SJ, Costa DN, Desai NB, Hydrogel Spacer Rectal Wall Infiltration Assoiciated with Severe Rectal Injury following Dose intensified Prostate Cancer Stereotactic Ablative Radiotheapy. Advances in radiation oncology, 2020. In press.
 
Understanding the Financial Toxicities of Brachytherapy
Mitchell Kamrava, MD
on behalf of the Socioeconomic Committee
 In the era of value-driven healthcare, it’s important that we understand how we determine value. Michael Porter’s commonly cited equation is that value is equal to patient-relevant outcomes divided by costs. So maximum patient value comes from the highest patient-relevant outcomes for the lowest costs. Determining the components of patient-relevant outcomes is complex and includes a myriad of things including chances of cure, chances of temporary side effects, and long-term impact on quality of life. Another factor is financial toxicity, which has been less acknowledged but high levels are associated with poor disease outcomes. Financial toxicity includes a constellation of things that encompasses the economic consequences and burdens resulting from a cancer diagnosis and treatment. A recent review on this topic by Imber B et al provides a framework for thinking about how to evaluate financial toxicity. They describe 5 different areas which contribute to patient-reported financial toxicity:

1) Direct costs – a patient’s out of pocket responsibilities
2) Indirect costs – opportunity costs (e.g. lost income due to inability to work)
3) Patient-specific values – a patient’s personal preferences and perceptions which influence how they react to medical-related expenses
4) Expectations of possible financial burdens – a patient’s knowledge and perception of the economic effect that a cancer diagnosis will have on their family
5) Individual economic circumstances – a patient’s baseline wealth that might impact eventual toxicity

There is limited data investigating the financial toxicities associated following brachytherapy. Given the significant impact financial toxicities can have on patients and their families additional investigation needs to be conducted in this area. 

There are various ways one can assess financial toxicity in their patients. The simplest is incorporating a single question during your clinical assessment of “are you having difficulty paying for your medical care?”. A more comprehensive screening tool is the Comprehensive Score for Financial Toxicity (COST). Recent studies performed on patients receiving radiation therapy demonstrates 15% of patients reported grade 2-3 COST toxicity, corresponding to a moderate or severe effect on the quality of life. Patients with a rural residence were independently associated with worse financial toxicity.

Considering the financial toxicity of our treatments is an important consideration that we should all work on integrating into our discussions with patients.  Learning more about the financial toxicities following brachytherapy is needed so that we can better maximize patient-relevant outcomes in our goal to optimize patient value.  

References
Imber B, Varghese M, Ehdaie B, et al. Financial toxicity associated with the treatment of localized prostate cancer. Nature Reviews Urology 17, 28-40 (2020).
Shih Y, Nasso S, Zafar S. Price transparency for whom? In search of out-of-pocket cost estimates to facilitate cost communication in cancer care. Pharmacoeconomics 36:259-261 (2018). 
de Souza J, Yap B, Hlubocky F, et al. The development of a financial toxicity patient-reported outcome in cancer: The COST measure. Cancer 120, 3245-53 (2014).
D’Rummo K, Miller L, TenNapel M, et al. Assessing the financial toxicity of radiation oncology patients using the validated comprehensive score for financial toxicity as a patient-reported outcome. Pract Radiat Oncol, 10, e322-e329 (2020). 

World Congress of Brachytherapy Wrap-Up
Firas Mourtada, PhD, President, ABS
I.M.Jurgenliemk-Schulz, MD, PhD, Chair of GEC-ESTRO
The World Congress of Brachytherapy (WCB) 2021 took place from 6-8 May. Due to Covid-19, the congress was organized using a fully digital platform that brought the international brachytherapy community together. WCB is traditionally organized by the European Society for Radiotherapy and Oncology (ESTRO) or American Brachytherapy Society (ABS) and is supported by several continental brachytherapy societies worldwide (Australasian Brachytherapy Group- ABG; Asociación Ibero Latinoamericana de Terapia Radiante Oncológica- ALATRO; Canadian Brachytherapy Group- CBG; Federation of Asian Organizations for Radiation Oncology- FARO; Indian Brachytherapy Society- IBS). This year the congress was organized by ESTRO. The Groupe Européen de Curiethérapie (GEC)-ESTRO led the efforts in the development of the scientific program with Dr. Bradley Pieters in the lead.

In a variety of teaching lectures, symposia, debates, proffered paper sessions, poster presentations, current and future topics of brachytherapy have been addressed, covering a variety of clinical and physical aspects in the field. The different sessions were well attended and despite the digital format, lively and interesting discussions were possible. This was especially true for a total of six debates and forum discussions. These sessions covered more or less controversial aspects regarding brachytherapy fractionation schedules for dedicated situations in prostate and breast cancer, brachytherapy contributions to combined treatments, and developments for a sustainable brachytherapy future.

Traditionally, during this congress, an outstanding colleague in the field of brachytherapy is honored with brachytherapy’s highest award, the Marie Curie Medal. This year our gold medal was given to Dr Alvaro Martinez for his outstanding scientific contribution, empathy and compassion, and his never-ending effort in optimizing radiation treatment and especially brachytherapy. His high-level award lecture was appreciated as well as the introduction by Dr. Frank Vicini. Dr. Martinez emphasized that we must work together today more than ever, to ensure that the true value of brachytherapy worldwide is conveyed, not only to the health care policymakers but also in recruiting the next generation of brachytherapists. To address these current challenges, the ABS has formed a special task force to address the new RO-APM [ECC1] model impact on both cervical and prostate cancer brachytherapy that will take effect in 2022, as well as the 300 in 10 initiative with the support from our industry partners to educate more brachytherapists. To watch the Marie Curie Medal Award session, please use this link in your browser: https://player.vimeo.com/video/546422806

The World Congress of Brachytherapy 2021 attracted more than 600 participants and included valuable contributions from our industry partners. 
 
ABS 2021 Virtual Conference
Innovations in a Time of Change
June 22 – 25, 2021 | Virtual Conference
9:00 am - 4:30 pm Eastern
The American Brachytherapy Society (ABS) is excited to present our 2021 conference as a fully virtual event! Charge those laptops and be prepared to experience this year's conference in a new, innovative – and convenient – way. Here's a glimpse of what you can expect.
To guide you through the 2021 annual meeting and help maximize your time, we will be highlighting some of this year's sessions. This week, join Drs. Susan Richardson and Navesh Sharma, 2021 Scientific Program Disease Site Chairs - Radiopharmaceuticals

Consensus Statements - Call for Authors!
ABS Consensus Statement on American Brachytherapy Society Consensus Guidelines for High Dose Rate Brachytherapy for Cervical Cancer

The most recent iteration of ABS consensus guidelines for cervical cancer brachytherapy was written in 2011 and is split into three parts; General Concepts, HDR, and LDR/PDR. These oft-referenced guidelines provide a foundation for modern brachytherapy practice, though over the past decade there have been significant advancements in our technique and understanding. In order to capture these advancements, the ABS Board of Directors has approved an update to the ABS Consensus Guidelines for cervical cancer brachytherapy. Given the changes in practice, it is anticipated that this refresh will consolidate parts I and II of the existing guidelines and result in a unified manuscript detailing contemporary HDR brachytherapy entitled “American Brachytherapy Society consensus guidelines for locally advanced cervical cancer brachytherapy”. Some of the proposed updates include further solidification of 3D planning with the incorporation of ICRU 89 recommendations, additional guidance on hybrid applicator use, integration of current FIGO staging, modernization of treatment planning objectives, and dose-constraints with a brief discussion of outcomes.

If interested in participating in this work, or if you have any suggestions, please contact Scott Glaser at sglaser@coh.org and please cc Melissa at mpomerene@virtualinc.com.  

ABS Consensus Guideline on Salvage Brachytherapy Using LDR/HDR After Prior Definitive Radiation for Prostate Cancer.  

We are starting to put together a group of authors for an upcoming ABS consensus guideline on salvage brachytherapy using LDR/HDR after prior definitive radiation for prostate cancer. This project will include a systematic review of the salvage literature as well as a process to establish consensus on best practices.

If you have interest in participating in this consensus guideline please contact Mitch Kamrava at Mitchell.Kamrava@cshs.org and cc Melissa Pomerene at mpomerene@virtualinc.com.  

American Brachytherapy Society and Indian Brachytherapy Society Consensus Statement on Establishing a High Dose Rate Brachytherapy
Program for Gynecologic Malignancies in Low-and Middle-Income Countries

Over the last several month's members of the American Brachytherapy Society (ABS) and the Indian Brachytherapy Society (IBS) have come together to formulate a list of key implementation components for establishing a brachytherapy program for gynecological malignancies in resource-limited settings. This guide builds upon existing publications on radiotherapy and cervical cancer in LMICs to provide a broad, yet practical framework for implementing HDR brachytherapy programs in such settings. We are encouraging further collaboration from ABS members with expertise and interest in gynecologic brachytherapy.

If you have interest in participating in this consensus guideline please contact Surbhi Grover Surbhi.Grover@pennmedicine.upenn.edu and cc Melissa Pomerene at mpomerene@virtualinc.com for further participation.

The deadline to respond is June 11, 2021

Approval Process of ABS Consensus Statements

In order to provide ABS members updates on standard brachytherapy management through the development of updated and/or new ABS consensus statements. We have updated our approval process of Consensus Statements.

The ABS Board of Directors (BOD) will select the topic, and senior and junior authors. The senior author will need to provide a list of publications and is required to have published on the topic of interest in the last 5 years. All proposed ABS consensus statements will include a summary paragraph detailing the subject matter and timeline. The ABS BOD requires that all authors who participate in these consensus statements are ABS members. It is recognized that contributing authors from other specialties will participate and are not required to be ABS members. If the proposed consensus statement is an update, the authors will need to reference the previous guidelines and summarize changes ( see attachment for a list of previous guidelines/statements). All ABS members will be notified through the ABS Blast of the proposed consensus statement for other interested co-authors to apply; a maximum of 10 authors will be selected. It is strongly encouraged that all authors, should have published or presented on the subject matter in the last 5 years. The timeline below details the process. Any controversies regarding authorship, subject content, or other issues will be resolved by the BOD consensus subcommittee.

Timeline Process:
  1. The ABS BOD will select the topic, junior and senior authors. ABS BOD will review the proposal for initial approval. Topics from non-board members will also be considered with ABS BOD approval.
  2. Notification to the ABS membership through the ABS Blast to identify the other 8 co-authors.
  3. Once final authorship is approved by the ABS BOD consensus sub-committee, the final document should be completed in 6 months and submitted to the President-elect or President for ABS BOD peer review by 2 members.
  4. Once the document is reviewed and approved by the ABS BOD, the document will be posted for “public comment” by the ABS membership for 30 days.
  5. Once the manuscript has been reviewed with additional edits incorporated, the authors will submit it to the Journal of Brachytherapy within 30 days.

Please e-mail your proposal and consensus document once done to Ann Klopp, MD, Ph.D., Vice President.
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2020-2021 ABS Board of Directors

Firas Mourtada, PhD, President
Ann Klopp MD, PhD, President Elect
Peter J. Rossi, MD, Vice President
Brett W. Cox, MD, Treasurer
Christopher L. Deufel, Secretary
Daniel G. Petereit, MD, Chairman of the Board
Peter F. Orio, III, DO, MS, Past Chairman of the Board

Directors-at-Large
  
Kristin Bradley, MD
Mitchell Kamrava, MD
Mira Keys, MD
Timothy Showalter, MD