2849 - Implementation and Optimization of a 3D-High Dose Rate Brachytherapy Program in a Comprehensive Cancer Center in Sub-Saharan Africa

Purpose/Objective(s): Cervical cancer is a leading cause of cancer-related mortality in Low-and Middle-Income Countries (LMICs), with Tanzania bearing a substantial burden. High-dose rate (HDR) brachytherapy is a critical component of cervical cancer treatment; however, its implementation is hindered by infrastructure limitations, costs, and workforce shortages. This study describes the development and optimization of a 3D-HDR brachytherapy program and deployment of auto contouring/planning software at an institution in Tanzania, highlighting successes, challenges, and strategies for sustainability.

Materials/Methods: A collaborative initiative was established to transition from 2D to 3D image-guided brachytherapy (IGBT). A needs-based assessment identified gaps in training, treatment planning, and workflow efficiency. The implementation strategy included remote didactics, physics-led QA training, hands-on training, and infrastructure support for 3D brachytherapy planning using computed tomography (CT)-based imaging. An on-site quality assurance review was performed for the HDR treatment delivery systems, inventory of applicators, and treatment planning system (TPS). Resources were developed to improve workflow and plan quality evaluation. An auto contouring tool was also implemented. Dosimetric comparisons between 2D and 3D treatment plans were performed as part of an ongoing prospective study to assess improvements in target coverage and organ-at-risk (OAR) sparing.

Results: Over two years, the integration of CT-based brachytherapy planning at the institute led to measurable improvements in treatment accuracy and quality. 121 patients were treated using 3D brachytherapy. Dosimetric analyses demonstrated enhanced high-risk clinical target volume (HR-CTV) coverage while achieving OAR dose constraints. Training initiatives improved staff proficiency in 3D contouring, dose optimization, applicator maintenance, plan evaluation, and cumulative dose monitoring. Key challenges included limited human resource capacity, lack of MRI access for advanced planning, high patient volumes exceeding treatment capacity, limited infrastructure for robust treatment planning, and the need for continued education to ensure long-term sustainability. Despite these barriers, the program has expanded access to 3D-HDR brachytherapy in Tanzania, serving as a scalable model for other LMICs.

Conclusion: Implementation of 3D-HDR brachytherapy represents a critical advancement in cervical cancer care in Tanzania. Through strategic partnerships, hands-on training, and workflow optimization, improvements in treatment delivery and patient outcomes were achieved. Ongoing efforts are required to address workforce shortages, equipment maintenance, auto contouring/planning tools, and MRI-based planning. Expanding such initiatives across LMICs is essential to reducing global disparities in gynecologic cancer treatment.