Introduction to Brachytherapy
Presentation Overview
What is Cancer?
Principles of Radiation Oncology
Introduction to Brachytherapy
Typical Treatment Process
Q&A
What is Cancer ?
Cancer is related to:
• Growth
• Differentiation
• Tissue integrity
TUMORcells
CARCINOMA
TRANSPORT
INVASIE
AANHECHTING
HYPERPLASIE
EXTRAVASATIE
INTERVASATIE
DYSPLASIE
Metastasis
IN SITU
Healthy
cells
organ 2
TUMORcells
Blood vessel
organ 1
Capillary
Cancer Treatment Options
SURGERY
CHEMOTHERAPY
BRACHYTHERAPY
HORMONE-THERAPY
IMMUNOTHERAPY
RADIOTHERAPY
Principles of Radiation Oncology
Damaging cells with radiation until
cell repair is not possible anymore
Repair possibility of “normal”
tissue is higher than of tumor cells
Cell Sterilization
with Ionizing Radiation
Particle
Cell Nucleus
Electron microscope image of
multiplying cells
Chromosome
cell
Why Brachytherapy?
Cancer
Alternative:
Surgery
Brachytherapy
End result
What is Brachytherapy with
Remote Afterloading?
Brachytherapy is Greek for:
Brachy = short distance, close-in
Therapy = treatment
Remote Afterloading is:
Cancer treatment with radioactive
sources controlled from a distance
Why Brachytherapy?
3-Fields External Beam
AP-PA External Beam
Brachytherapy
Highly conformal
Conformal Brachytherapy
Treat only tumor
tissue
Spare healthy tissue
Dose is
determined by:
Source Strength
Exposure Time
Source Position
Brachytherapy: Advantages
Higher local control, due to higher dose to
target volume
Less dose to surrounding tissue due to
sharp fall-off of radiation dose
Higher treatment dose delivered to the
center of the tumor which is more radiation
resistant
More conformal treatment due to stepping
source technique
Brachytherapy: Disadvantages
Hazard of radiation exposure
Potential patient hospitalization
Only local treatment
Special skills and training are needed
Licensing and credentialing needed
Complete coverage of target volume
is essential
Surgical trauma in the case of
interstitial techniques
Brachytherapy Delivery Methods
Liquids
Phosphorous (blood disorders)
Strontium (bone cancer)
Iodine (thyroid)
Implants
Permanent
(Au-198 or I-125 seeds for prostate)
Temporary
(wires or afterloading techniques)
Treatments by Type of Loading
Manual “hot” loading
Manual Afterloading
Remote Afterloading
Brachytherapy Remote
Afterloading Methods
Low Dose Rate
Cesium pellets or Iridium wires,
treatment 1-3 days
High Dose Rate
Cobalt-60 pellets, Iridium-192 10 Ci source,
treatment in minutes
Pulsed Dose Rate
Iridium-192 1 Ci source, treatment 1-3 days
Afterloader: Low Dose Rate (LDR)
Cesium spheres and Iridium wires
no real optimization possible
long treatment times (days)
well known radiobiological and late
effects
1978
Afterloader: High Dose Rate (HDR)
Stepping Iridium-192 source (10 Ci)
200+ applicators for body site
specific treatments
Programmable variable source
positioning via steps and dwell times
Short treatment times (minutes)
1986 - present
Afterloader: Pulsed Dose Rate (PDR)
stepping Iridium source (0.5 - 2Ci)
no limitation to body sites and curvatures
optimization possible
short radiation times (minutes)
long treatment times (days)
requires less shielding
1986 - present
Brachytherapy Components
Planning Systems
Imaging
devices
Remote
Afterloaders
Body-site Specific
Applicators
Treatments by Location
Intracavitary techniques
(i.e. Vaginal, Rectum)
Intraluminal techniques
(i.e. Lung)
Interstitial techniques
(i.e. Breast, Prostate)
Surface applications
(i.e. Skin)
Synergy with Brachytherapy
Brachytherapy – External beam
Brachytherapy – Surgery
Per-operative
Pre-operative (improves surgical outcome)
Brachytherapy – Chemotherapy
Brachytherapy - Hyperthermia
Nucletron is the Solution
microSelectron Digital
Afterloader for HDR & PDR
Body-site Specific Solutions
PLATO & Oncentra Treatment
Planning Systems
Training Leadership
Technical Support
Licensing Support
Reimbursement Support
Service
History of Radiation Oncology
& Brachytherapy
Question & Answers