Trends in brachytherapy utilization in Canada from 2011 to 2020

Brachytherapy is a highly conformal and cost-effective radiotherapy modality, yet its clinical utilization has declined in multiple regions. This study investigated trends in brachytherapy utilization across different Canadian provinces from 2011 to 2020.

A national survey was distributed to medical physicists in cancer centres across ten Canadian provinces, collecting data on types of brachytherapy, annual number of treatments, clinical indications, and logistical factors. In Québec, treated clinical indications were obtained through a complementary survey of all radiotherapy centres, extending previously published provincial brachytherapy data.

Out of 39 radiotherapy centres in Canada conducting brachytherapy treatments, 25 centres were included in this study. HDR accounted for the majority of treatments (60%-100%) and increased in most provinces, while LDR declined across reporting provinces; PDR comprised $\le$ 10% of treatments and was limited to Alberta and Ontario. After adjusting for indication-specific cancer incidence and combining HDR and LDR brachytherapy, utilization trends showed decreases in Alberta and British Columbia, increases in Ontario, Nova Scotia, and Saskatchewan, and no significant change in Manitoba, Québec, or nationally.

This study revealed significant regional variations in brachytherapy utilization and clinical practices across Canadian radiotherapy centres. Factors influencing these trends include reimbursement structures, personnel and infrastructure availability, and clinician preferences. The use of HDR modalities is increasing nationally, while LDR is declining. Despite significant regional differences, brachytherapy utilization in Canada was largely sustained over the decade from 2011 to 2020.