THE IMPACTOFATHREE-INSERTIONS PROTOCOL FOR HIGH DOSE RATE BRACHYTHERAPY IN GYNECOLOGICAL CANCER IN THE PUBLIC HEALTH SYSTEM

In Brazil, the most used high dose rate brachytherapy (HDR) protocol contemplates four insertions (P4). Currently, there is scientific evidence that a three-insertions protocol (P3) is safe and effective. To assess the impact of P3 on the coverage of the demand for gynecological HDR in the country, we characterized and compared the installed capacity of HDR services with its estimated demand for P4 versus P3. Data on the number of HDR facilities providing treatment and insertions performed in the Public Health System (SUS) between 2011 and 2016 were obtained via DataSUS. Need for gynecological HDR was obtained by estimating the incidence of cervical and uterine cancer for the period, by Federative Unit (FU), adjusted for compatible staging. In 2016, 45% of radiotherapy facilities at SUS provided HDR, with an increase in services offering HDR in the last five years (total increase of 13.8%). Surprisingly, the number is lower than that reported in a national survey from 2009. Four FUs do not offer treatment. There is a concentration of facilities in the southeast region (55%). In 2016, the estimated demand for insertions for P4 was 46,400, but only 32,500 were registered, generating a deficit of 13,900 insertions (coverage of 70% of the demand). Only three FUs were self-sufficient. In the P3 scenario, eleven FUs becoming self-sufficient in meeting their needs for HDR. Even with P3, the national distribution of HDR remains unbalanced. However, the deficit would be reduced from 30% to 7%, improving local care, with no additional costs to SUS, due to the new remuneration model.