ABSTRACT
Brachytherapy is the ultimate form of conformal radiotherapy (RT) with an ability to deliver high doses to the tumor while sparing the adjacent normal structures due to the steep dose gradient. There is a disturbing trend in the United States whereby the use of brachytherapy is in rapid decline for prostate, cervical, vaginal, and inoperable endometrial cancer. Even though prostate brachytherapy is the least costly alternative, with outcomes as good if not superior to other modalities, two recent studies detail a significant decrease in utilization. With the expansion of health care under the Affordable Healthcare Act (ACA) in the United States, it is possible that patients may present with earlier stages of cancer, and therefore, increase the population base eligible for brachytherapy. Some countries in Europe, such as Denmark and the United Kingdom have policies to centralize brachytherapy and RT services which translate into larger centers but this is certainly not the case in the majority of countries.
