Ultrasound Image Based High Dose Rate (HDR) Brachytherapy in Locally Advanced Cancer Cervix

AbstractConcurrent chemoradiotherapy is considered the standard treatment for the locally advanced cancer cervix (LACC). Radiotherapy is commonly administered by a three-dimensional conformal radiotherapy (3DCRT) approach followed by brachytherapy (BT). High dose rate (HDR) BT is commonly administered; however, several drawbacks exist including invasive technique, pain, requirement of anesthesia, and operative risks. We assessed the dosimetric difference between the HDR BT and the volumetric modulated arc therapy (VMAT) boost in those patients. Ten patients were selected retrospectively with LACC and all received whole pelvis radiotherapy followed by BT boost of 7 Gy in three fractions. The computed tomography (CT) image was transferred to the Varian system for the VMAT plan while the one with the applicator was transferred to the Sagi planning system and the high-risk clinical target volume (HR-CTV), bladder, rectum, sigmoid, and small bowel were delineate with a margin of 5 mm were added to the CTV to create the planning target volume (PTV). The D90 for the PTV in VMAT boost was lower than received by the HR-CTV in the BT boost. Mean volume of the PTV was higher than that of the HR-CTV. The D2cc was higher in VMAT for bladder, sigmoid, and rectum while the D2cc for the small bowel in BT was higher compared with the VMAT. The VMAT is an option that exists for patients who refuse BT or cannot tolerate it, or in case of nonavailability of BT or a nonworking machine.

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Clinical Investigations Perioperative high dose rate (HDR) brachytherapy in unresectable locally advanced pancreatic tumors

Journal of Contemporary Brachytherapy ◽

10.5114/jcb.2011.23202 ◽

2011 ◽

Vol 2 ◽

pp. 84-90

Author(s):

Dariusz Waniczek ◽

Jerzy Piecuch ◽

Marek Rudzki ◽

Wojciech Mikusek ◽

Jerzy Arendt ◽

...

Keyword(s):

Dose Rate ◽

Locally Advanced ◽

High Dose Rate ◽

Pancreatic Tumors ◽

High Dose ◽

Hdr Brachytherapy ◽

Clinical Investigations

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High–dose rate brachytherapy in the treatment of carcinoma of uterine cervix: twenty-year experience with cobalt after-loading system

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200605000-00024 ◽

2006 ◽

Vol 16 (3) ◽

pp. 1101-1105

Author(s):

A. Mosalaei ◽

M. Mohammadianpanah ◽

S. Omidvari ◽

N. Ahmadloo

Keyword(s):

Dose Rate ◽

Treatment Planning ◽

Uterine Cervix ◽

Locally Advanced ◽

Disease Free Survival ◽

High Dose Rate ◽

High Dose ◽

Hdr Brachytherapy ◽

Gastrointestinal Complications ◽

Fractionation Schedule

This retrospective analysis aims to report results of patients with cancer of uterine cervix treated with external-beam radiotherapy (EBR) and high–dose rate (HDR) brachytherapy, using manual treatment planning. From 1975 to 1995, 237 patients with FIGO stages IIB–IVA and mean age of 54.31 years were treated. EBR dose to the whole pelvis was 50 Gy in 25 fractions. Brachytherapy with HDR after-loading cobalt source (Cathetron) was performed following EBR completion with a dose of 30 Gy in three weekly fractions of 10 Gy to point A. Survival, local control, and genitourinary and gastrointestinal complications were assessed. In a median follow-up of 60.2 months, the 10-year overall and disease-free survival rate was 62.4%. Local recurrence was seen in 12.2% of patients. Distant metastases to the lymph nodes, peritoneum, lung, liver, and bone occurred in 25.3% of patients. Less than 6% of patients experienced severe genitourinary and/or gastrointestinal toxicity that were relieved by surgical intervention. No treatment-related mortality was seen. This series suggests that 50 Gy to the whole pelvis together with three fractions of 10 Gy to point A with HDR brachytherapy is an effective fractionation schedule in the treatment of locally advanced cancer of cervix. To decrease the complications, newer devices and treatment planning may be beneficial.

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A critical evaluation of the clinical value of high-dose rate brachytherapy in the treatment of prostate cancer

Journal of Radiotherapy in Practice ◽

10.1017/s146039690600032x ◽

2006 ◽

Vol 5 (4) ◽

pp. 227-232 ◽

Cited By ~ 2

Author(s):

E. C. Sharman

Keyword(s):

Prostate Cancer ◽

Dose Rate ◽

Large Fraction ◽

External Beam Radiotherapy ◽

Locally Advanced ◽

Critical Evaluation ◽

High Dose Rate ◽

High Dose ◽

Hdr Brachytherapy ◽

Ldr Brachytherapy

Prostate cancer has been treated with low-dose rate (LDR) brachytherapy for early localised disease in the form of permanent seed implants, with all its inherent problems in terms of dosimetry and seed migration. High-dose rate (HDR) brachytherapy has mainly been utilised as a boost to external beam radiotherapy (EBRT) in patients with locally advanced disease. However, limited studies investigating HDR as a monotherapy for early local disease are yielding promising results in terms of biochemical control and reduced toxicity. With the ability to optimise the plan and conform the dose, dose escalation can be achieved whilst sparing normal tissue. Recent studies to assess the α/β ratio of prostate cancer have shown this to be low, making this tumour sensitive to large fractions or hypofractionation. The HDR delivery and large fraction sizes may be advantageous in tumours sensitive to radiation fraction size making HDR brachytherapy the treatment of choice over LDR brachytherapy and EBRT.

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