Content deleted Content added
Citation bot (talk | contribs) Alter: pages. Add: issue, volume. Formatted dashes. | Use this bot. Report bugs. | Suggested by AManWithNoPlan | #UCB_CommandLine |
m →Treatment delivery: clean up, replaced: = HCUP Statistical Brief # → =HCUP Statistical Brief |issue= |
||
| (25 intermediate revisions by 17 users not shown) | |||
Line 1:
{{Short description|Type of radiation therapy}}
{{cs1 config|name-list-style=vanc}}
{{EngvarB|date = February 2019}}
{{Infobox medical intervention
Line 15 ⟶ 16:
'''Brachytherapy''' is a form of [[radiation therapy]] where a sealed [[radiation|radiation source]] is placed inside or next to the area requiring treatment. ''Brachy'' is [[Greek language|Greek]] for short. Brachytherapy is commonly used as an effective treatment for [[cervical cancer|cervical]], [[Prostate cancer|prostate]], [[Breast cancer|breast]], [[Esophageal cancer|esophageal]] and [[skin cancer]] and can also be used to treat tumours in many other body sites.<ref name="GEC-ESTRO">{{Cite book | editor1-last = Gerbaulet | editor1-first = Alain | editor2-last = Pötter | editor2-first = Richard | editor3-last = Mazeron | editor3-first = Jean-Jacques | editor4-last = Meertens | editor4-first = Harm | editor5-last = Limbergen | editor5-first = Erik Van | year = 2002 | title = The GEC ESTRO handbook of brachytherapy | publisher = European Society for Therapeutic Radiology and Oncology | location = Leuven, Belgium | oclc=52988578}}</ref> Treatment results have demonstrated that the cancer-cure rates of brachytherapy are either comparable to surgery and [[external beam radiotherapy]] (EBRT) or are improved when used in combination with these techniques.<ref name="Viswanathan 2007">{{Cite book | last = Viswanathan AN | editor = Devlin P | year = 2007 | title = Brachytherapy: Applications and Techniques | chapter = Gynecologic brachytherapy | publisher = LWW | location = Philadelphia | display-authors = etal }}</ref><ref name="Kishan-2018">{{Cite journal | first1 = Amar |last1=Kishan | first2 = Ryan |last2=Cook| first3 = Jay | last3=Ciezki|display-authors=et al|title = Radical Prostatectomy, External Beam Radiotherapy, or External Beam Radiotherapy With Brachytherapy Boost and Disease Progression and Mortality in Patients with Gleason Score 9-10 Prostate Cancer| journal = JAMA| volume = 319 |issue=9 | pages = 896–905| year = 2018 | doi = 10.1001/jama.2018.0587|pmid=29509865 |pmc=5885899 }}</ref><ref name="Pieters -2009">{{Cite journal| first1 = B. R. | first2 = D. Z.| first3 = C. C. E.| last1 = Pieters| first4 = A. H.| title = Comparison of three radiotherapy modalities on biochemical control and overall survival for the treatment of prostate cancer: A systematic review| journal = Radiotherapy and Oncology| volume = 93| pages = 168–173| year = 2009 | doi = 10.1016/j.radonc.2009.08.033| pmid = 19748692| last2 = De Back| last3 = Koning| last4 = Zwinderman| issue = 2}}</ref> Brachytherapy can be used alone or in combination with other therapies such as surgery, EBRT and [[chemotherapy]].
Brachytherapy contrasts with [[unsealed source radiotherapy]], in which a therapeutic [[radionuclide]] (radioisotope) is injected into the body to chemically localize to the tissue requiring destruction. It also contrasts to External Beam Radiation Therapy (EBRT), in which high-energy x-rays (or occasionally gamma-rays from a radioisotope like [[cobalt-60]]) are directed at the tumour from outside the body. Brachytherapy instead involves the precise placement of short-range radiation-sources (radioisotopes, [[iodine-125]] or [[
A feature of brachytherapy is that the irradiation affects only a very localized area around the radiation sources. Exposure to radiation of healthy tissues farther away from the sources is therefore reduced. In addition, if the patient moves or if there is any movement of the tumour within the body during treatment, the radiation sources retain their correct position in relation to the tumour. These characteristics of brachytherapy provide advantages over EBRT – the tumour can be treated with very high doses of localised radiation whilst reducing the probability of unnecessary damage to surrounding healthy tissues.<ref name="GEC-ESTRO" />{{rp|Ch. 1}}<ref name="Stewart 2007" />
Line 25 ⟶ 26:
==Medical uses==
[[File:Clinical applications of brachytherapy.jpg|thumb|upright=1.5|Body sites in which brachytherapy can be used to treat cancer
Brachytherapy is commonly used to treat cancers of the [[cervix]], [[prostate]], [[breast]], and [[skin]].<ref name="GEC-ESTRO" />
Line 33 ⟶ 34:
The use of HDR brachytherapy enables overall treatment times to be reduced compared with EBRT.<ref name="Joseph-2008">
{{Cite journal| first1 = K. J.| last1 = Joseph | first2 = R.| first3 = D.| first4 = J.| first5 = N.| first6 = C.| last2 = Alvi| last6 = Small| last3 = Skarsgard| last5 = Pervez| last4 = Tonita| last7 = Tai | first7 = P.| title = Analysis of health related quality of life (HRQoL) of patients with clinically localized prostate cancer, one year after treatment with external beam radiotherapy (EBRT) alone versus EBRT and high dose rate brachytherapy (HDRBT)| journal = Radiation Oncology| volume = 3| pages = 20| year = 2008 | doi = 10.1186/1748-717X-3-20| pmid = 18627617| pmc = 2494997 | doi-access = free }}</ref><ref name="Holmboe-2000">
{{Cite journal | pmid = 11089712 | year = 2000 | author1 = Holmboe | first2 = J. | title = Treatment decisions for localized prostate cancer: asking men what's important | volume = 15 | issue = 10 | pages = 694–701 | pmc = 1495597 | journal = Journal of General Internal Medicine | doi = 10.1046/j.1525-1497.2000.90842.x | last2 = Concato}}</ref>
Patients receiving brachytherapy generally have to make fewer visits for radiotherapy compared with EBRT, and overall radiotherapy treatment plans can be completed in less time.<ref name="Hoskin 2005 book">
Line 43 ⟶ 44:
Brachytherapy can be used with the aim of curing the cancer in cases of small or locally advanced tumours, provided the cancer has not metastasized (spread to other parts of the body). In appropriately selected cases, brachytherapy for primary tumours often represents a comparable approach to surgery, achieving the same probability of cure and with similar side effects.<ref name="Guedea-2009">
{{Cite journal | doi = 10.1007/s12094-009-0387-x | last1 = Guedea | first1 = F. | last2 = Ferrer | first2 = M. | last3 = Pera | first3 = J. | last4 = Aguiló | first4 = F. | last5 = Boladeras | first5 = A. | last6 = Suárez | first6 = J. F. | last7 = Cunillera | first7 = O. | last8 = Ferrer | first8 = F. | last9 = Pardo | first9 = Y. | last10 = Martínez | first10 = E. | last11 = Ventura | first11 = M. | title = Quality of life two years after radical prostatectomy, prostate brachytherapy or external beam radiotherapy for clinically localised prostate cancer: The Catalan Institute of Oncology/Bellvitge Hospital experience | journal = Clinical & Translational Oncology | volume = 11 | issue = 7 | pages = 470–478 | year = 2009 | pmid = 19574206| s2cid = 22946298 }}</ref><ref name="Litwin-2007">
{{Cite journal| first1 = M. S.| last1 = Litwin | first2 = J. L.| first3 = L.| first4 = J. M.| first5 = S. P.| first6 = H. R.| first7 = R. E.| title = Quality of life after surgery, external beam irradiation, or brachytherapy for early-stage prostate cancer| journal = Cancer| volume = 109| pages = 2239–2247| year = 2007 | doi = 10.1002/cncr.22676| pmid = 17455209| last2 = Gore| last3 = Kwan| last4 = Brandeis| last5 = Lee| last6 = Withers| last7 = Reiter| issue = 11| doi-access =
However, in locally advanced tumours, surgery may not routinely provide the best chance of cure and is often not technically feasible to perform. In these cases radiotherapy, including brachytherapy, offers the only chance of cure.<ref name="Pistis -2009">
{{Cite journal| first1 = F.| first2 = F.| first3 = J.| last1 = Pistis| first4 = C.| first5 = M.| first6 = A.| first7 = E.| first8 = A.| first9 = F.| last10 = Gabriele | first10 = P.| last11 = Linares | first11 = L.| title = External beam radiotherapy plus high-dose-rate brachytherapy for treatment of locally advanced prostate cancer: the initial experience of the Catalan Institute of Oncology| journal = Brachytherapy| year = 2009 | doi = 10.1016/j.brachy.2009.05.001| last2 = Guedea| last3 = Pera| last4 = Gutierrez| last5 = Ventura| last6 = Polo| last7 = Martinez| last8 = Boladeras| last9 = Ferrer| volume = 9| pages = 15–22| pmid = 19734106| issue = 1}}</ref><ref name="Lertsanguansinchai-2004">
Line 50 ⟶ 51:
In cases where the tumour is not easily accessible or is too large to ensure an optimal distribution of irradiation to the treatment area, brachytherapy can be combined with other treatments, such as EBRT and/or surgery.<ref name="GEC-ESTRO" />{{rp|Ch. 1}} Combination therapy of brachytherapy exclusively with chemotherapy is rare.<ref name="Roddiger-2006">
{{Cite journal | author = Roddiger SJ | year = 2006 | title = Neoadjuvant interstitial high-dose-rate (HDR) brachytherapy combined with systemic chemotherapy in patients with breast cancer | journal = Strahlenther Onkol | volume = 182 | issue = 1 | pages = 22–9 | pmid =16404517 | doi = 10.1007/s00066-006-1454-7 | s2cid = 23210347 | url = https://boris.unibe.ch/20639/ | display-authors = etal }}</ref>
===Cervical cancer===
Line 67 ⟶ 68:
The chances of staying free of disease (disease-free survival) and of staying alive (overall survival) are similar for LDR, PDR and HDR treatments.<ref name="Lertsanguansinchai-2004" /><ref name="Hareyama-2002">
{{Cite journal | doi = 10.1002/cncr.10207 | title = High-dose-rate versus low-dose-rate intracavitary therapy for carcinoma of the uterine cervix | pmid = 11815967 | year = 2002 | last1 = Hareyama | first1 = M
However, a key advantage of HDR treatment is that each dose can be delivered on an outpatient basis with a short administration time<ref name="Viswanathan 2007" /> providing greater convenience for many patients.
Line 82 ⟶ 83:
{{Cite journal| last1 = Morris | first1 = W. J.| first2 = M.| first3 = D.| first4 = M.| first5 = I.| first6 = A.| first7 = T.| first8 = M.| first9 = W.| last10 = Wu | first10 = J.| last11 = Lapointe | first11 = V.| last12 = Berthelet | first12 = E.| last13 = Pai | first13 = H.| last14 = Harrison | first14 = R.| last15 = Kwa | first15 = W.| last16 = Bucci | first16 = J.| last17 = Racz | first17 = V.| last18 = Woods | first18 = R.| title = Evaluation of Dosimetric Parameters and Disease Response After 125Iodine Transperineal Brachytherapy for Low- and Intermediate-Risk Prostate Cancer| journal = International Journal of Radiation Oncology, Biology, Physics| volume = 73| pages = 1432–1438| year = 2009 | doi = 10.1016/j.ijrobp.2008.07.042| last2 = Keyes| last3 = Palma| last4 = McKenzie| last5 = Spadinger| last6 = Agranovich| last7 = Pickles| last8 = Liu| last9 = Kwan| pmid = 19036530| issue = 5}}</ref> and has been shown to be a highly effective treatment to prevent the cancer from returning.<ref name="Batterman-2004" /><ref name="Pickles-2009">
{{Cite journal| first1 = T.| last1 = Pickles | first2 = M.| first3 = W. J.| title = Brachytherapy or Conformal External Radiotherapy for Prostate Cancer: A Single-Institution Matched-Pair Analysis| journal = International Journal of Radiation Oncology, Biology, Physics| year = 2009| pmid = 19570619 | doi = 10.1016/j.ijrobp.2009.01.081| last2 = Keyes| last3 = Morris| volume = 76| issue = 1| pages = 43–49}}</ref> The survival rate is similar to that found with EBRT or surgery ([[radical prostatectomy]]), but with fewer side effects such as [[impotence]] and [[Urinary incontinence|incontinence]].<ref name="Frank-2007">
{{Cite journal| first1 = S.| last1 = Frank | first2 = L.| first3 = J.| first4 = A.| first5 = R.| first6 = D.| title = An Assessment of Quality of Life Following Radical Prostatectomy, High Dose External Beam Radiation Therapy and Brachytherapy Iodine Implantation as Monotherapies for Localized Prostate Cancer| journal = The Journal of Urology| volume = 177| pages = 2151–2156| year = 2007 | doi = 10.1016/j.juro.2007.01.134| pmid = 17509305| last2 = Pisters| last3 = Davis| last4 = Lee| last5 = Bassett| last6 = Kuban| issue = 6}}</ref> The procedure can be completed quickly and patients are usually able to go home on the same day of treatment and return to normal activities after
{{cite web|url=https://www.theguardian.com/lifeandstyle/besttreatments/prostate-cancer-treatments-internal-radiotherapy-brachytherapy |title=Prostate cancer: internal radiotherapy (brachytherapy) |access-date=25 September 2009 |author=BMJ Group |date=June 2009 |publisher=Guardian.co.uk |url-status=dead |archive-url=https://web.archive.org/web/20090404040935/http://www.guardian.co.uk/lifeandstyle/besttreatments/prostate-cancer-treatments-internal-radiotherapy-brachytherapy |archive-date=April 4, 2009 }}</ref>
Permanent seed implantation is often a less invasive treatment option compared to the surgical removal of the prostate.<ref name="BMJGroup-2009" />
Line 109 ⟶ 110:
==== Intraoperative radiation therapy ====
Intraoperative radiation therapy (IORT) delivers radiation at the same time as the surgery to remove the tumour (lumpectomy).<ref name=":1">{{Cite book|title=Accelerated Partial Breast Irradiation|last=Vaidya|first=Jayant S.|date=2009|publisher=Springer, Berlin, Heidelberg|isbn=9783540880059|pages=327–344|doi=10.1007/978-3-540-88006-6_19|chapter=APBI with 50 kV Photons: Targeted Intraoperative Radiotherapy (TARGIT)}}</ref> An applicator is placed in the cavity left after tumour removal and a mobile electronic device generates radiation (either x-rays<ref name=":1" /> or electrons<ref>{{Cite book|title=Accelerated Partial Breast Irradiation|last1=Orecchia|first1=Roberto|last2=Ivaldi|first2=Giovanni B.|last3=Leonardi|first3=Maria C.|chapter=APBI Intraoperative Technique with Electrons |date=2009|publisher=Springer, Berlin, Heidelberg|isbn=9783540880059|pages=345–366|doi=10.1007/978-3-540-88006-6_20}}</ref>) and delivers it via the applicator. Radiation is delivered all at once and the applicator removed before closing the incision.
====Intracavitary breast brachytherapy====
Line 117 ⟶ 118:
==== Permanent breast seed implantation ====
Permanent breast seed implantation (PBSI) implants many radioactive "seeds" (small pellets) into the breast in the area surrounding the site of the tumour, similar to permanent seed prostate brachytherapy.<ref name=":0">{{Cite book|title=Accelerated Partial Breast Irradiation|last1=Pignol|first1=Jean-Philippe|last2=Keller|first2=Brian M.|chapter=Permanent Breast Seed Implants |date=2009|publisher=Springer, Berlin, Heidelberg|isbn=9783540880059|pages=263–276|doi=10.1007/978-3-540-88006-6_15}}</ref> The seeds are implanted in a single
===Brain tumors===
Surgically Targeted Radiation Therapy (STaRT), branded as GammaTile Therapy, is a type of brachytherapy implant specifically designed for use inside the brain. GammaTile is FDA-cleared to treat newly diagnosed, operable malignant intracranial neoplasms (
In a clinical study, GammaTile Therapy improved local tumor control compared to previous same-site treatments without an increased risk of side effects.<ref>{{Cite web|url=https://www.aans.org/Annual-Scientific-Meeting/2019/Online-Program/Eposter?eventid=48888&itemid=SSI&propid=46135|title
=== Esophageal cancer ===
For [[esophageal cancer]] radiation treatment, brachytherapy is one option for effective treatment, involves definitive radiotherapy (boost)<ref>{{Cite journal|last1=Folkert|first1=Michael R.|last2=Cohen|first2=Gil'ad N.|last3=Wu|first3=Abraham J.|last4=Gerdes|first4=Hans|last5=Schattner|first5=Mark A.|last6=Markowitz|first6=Arnold J.|last7=Ludwig|first7=Emmy|last8=Ilson|first8=David H.|last9=Bains|first9=Manjit S.|date=September 2013|title=Endoluminal high-dose-rate brachytherapy for early stage and recurrent esophageal cancer in medically inoperable patients|journal=Brachytherapy|volume=12|issue=5|pages=463–470|doi=10.1016/j.brachy.2012.12.001|pmid=23434221|issn=1538-4721}}</ref><ref>{{Cite journal|last1=Hishikawa|first1=Yoshio|last2=Kurisu|first2=Kouichi|last3=Taniguchi|first3=Midori|last4=Kamikonya|first4=Norihiko|last5=Miura|first5=Takashi|date=October 1991|title=High-dose-rate intraluminal brachytherapy (HDRIBT) for esophageal cancer|journal=International Journal of Radiation Oncology, Biology, Physics|volume=21|issue=5|pages=1133–1135|doi=10.1016/0360-3016(91)90267-8|pmid=1938510}}</ref> or palliative treatments.<ref name="Fuccio 332–339">{{Cite journal|last1=Fuccio|first1=Lorenzo|last2=Mandolesi|first2=Daniele|last3=Farioli|first3=Andrea|last4=Hassan|first4=Cesare|last5=Frazzoni|first5=Leonardo|last6=Guido|first6=Alessandra|last7=de Bortoli|first7=Nicola|last8=Cilla|first8=Savino|last9=Pierantoni|first9=Chiara|date=March 2017|title=Brachytherapy for the palliation of dysphagia owing to esophageal cancer: A systematic review and meta-analysis of prospective studies|journal=Radiotherapy and Oncology|volume=122|issue=3|pages=332–339|doi=10.1016/j.radonc.2016.12.034|pmid=28104297}}</ref><ref>{{Cite journal|last1=Homs|first1=Marjolein YV|last2=Steyerberg|first2=Ewout W|last3=Eijkenboom|first3=Wilhelmina MH|last4=Tilanus|first4=Hugo W|last5=Stalpers|first5=Lukas JA|last6=Bartelsman|first6=Joep FWM|last7=van Lanschot|first7=Jan JB|last8=Wijrdeman|first8=Harm K|last9=Mulder|first9=Chris JJ|date=October 2004|title=Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial|journal=The Lancet|volume=364|issue=9444|pages=1497–1504|doi=10.1016/S0140-6736(04)17272-3|pmid=15500894|s2cid=29529166}}</ref> Definitive radiotherapy (boost) can deliver the dose precisely and palliative treatments can be given to relieve dysphagia. The large diameter applicators or balloon type catheter are used with the [[afterloader]] to expand the esophagus and facilitate the delivery of radiation dose to tumor with sparing of nearby normal tissue.<ref>{{Cite journal|last1=Nonoshita|first1=Takeshi|last2=Sasaki|first2=Tomonari|last3=Hirata|first3=Hideki|last4=Toh|first4=Yasushi|last5=Shioyama|first5=Yoshiyuki|last6=Nakamura|first6=Katsumasa|last7=Honda|first7=Hiroshi|date=2007-10-26|title=High-dose-rate brachytherapy for previously irradiated patients with recurrent esophageal cancer|journal=Radiation Medicine|volume=25|issue=8|pages=373–377|doi=10.1007/s11604-007-0152-4|pmid=17952540|s2cid=7294379|issn=0288-2043}}</ref><ref>{{Cite journal|last1=Akagi|first1=Yukio|last2=Hirokawa|first2=Yutaka|last3=Kagemoto|first3=Masayuki|last4=Matsuura|first4=Kanji|last5=Ito|first5=Atsushi|last6=Fujita|first6=Kazushi|last7=Kenjo|first7=Masahiro|last8=Kiriu|first8=Hiroshi|last9=Ito|first9=Katsuhide|date=February 1999|title=Optimum fractionation for high-dose-rate endoesophageal brachytherapy following external irradiation of early stage esophageal cancer|journal=International Journal of Radiation Oncology, Biology, Physics|volume=43|issue=3|pages=525–530|doi=10.1016/S0360-3016(98)00433-7|pmid=10078632}}</ref>
Brachytherapy followed EBRT or surgery have been
===Skin cancer===
HDR brachytherapy for nonmelanomatous [[skin cancer]], such as [[basal cell carcinoma]] and [[squamous cell carcinoma]], provides an alternative treatment option to surgery. This is especially relevant for cancers on the nose, ears, eyelids or lips, where surgery may cause disfigurement or require extensive reconstruction.<ref name="GEC-ESTRO" />{{rp|Ch. 28}} Various applicators can be used to ensure close contact between the radiation source(s) and the skin, which conform to the curvature of the skin and help ensure precision delivery of the optimal irradiation dose.<ref name="GEC-ESTRO" />{{rp|Ch. 28}}
Another type of brachytherapy which has similar advantages as the HDR is provided be the Rhenium-SCT ([[Skin cancer|Skin Cancer]] Therapy). It makes use of the beta ray emissions of [[Rhenium]]-188 to treat [[Basal-cell carcinoma|basal cell]]
Brachytherapy for skin cancer provides good cosmetic results and clinical efficacy; studies with up to
{{Cite journal | doi = 10.1016/S0360-3016(99)00547-7 | pmid = 10758310 | year = 2000 | author1 = Guix | first2 = F. | first3 = J. | first4 = C. | first5 = A. | first6 = J. | first7 = R. | title = Treatment of skin carcinomas of the face by high-dose-rate brachytherapy and custom-made surface molds | volume = 47 | issue = 1 | pages = 95–102 | journal = International Journal of Radiation Oncology, Biology, Physics | last2 = Finestres | last3 = Tello | last4 = Palma | last5 = Martinez | last6 = Guix | last7 = Guix}}</ref><ref name="Sedda-2008">
{{Cite journal| first1 = A. F.| last1 = Sedda | first2 = G.| first3 = C.| first4 = A. M.| first5 = P.| title = Dermatological high-dose-rate brachytherapy for the treatment of basal and squamous cell carcinoma| journal = Clinical and Experimental Dermatology| volume = 33| pages = 745–749| year = 2008 | doi = 10.1111/j.1365-2230.2008.02852.x| pmid = 18681873| last2 = Rossi| last3 = Cipriani| last4 = Carrozzo| last5 = Donati| issue = 6| hdl = 2108/59410 | s2cid = 26912830 |url=https://art.torvergata.it/bitstream/2108/59410/1/Dermatological%20high-dose-rate%20brachytherapy.pdf| hdl-access = free}}</ref><ref name="Rio-2005">
Line 162 ⟶ 163:
{{Cite journal | pmid = 15301172 | year = 2004 | author1 = Doust | first2 = E. | first3 = G. | first4 = M. | first5 = D. | title = A systematic review of brachytherapy. Is it an effective and safe treatment for localised prostate cancer? | volume = 33 | issue = 7 | pages = 525–529 | journal = Australian Family Physician | last2 = Miller | last3 = Duchesne | last4 = Kitchener | last5 = Weller}}</ref><ref name="Magné-2009">
{{Cite journal| last1 = Magné | first1 = N.| first2 = N. C.| first3 = E.| first4 = P.| first5 = P.| first6 = D.| first7 = C.| first8 = P.| first9 = C.| title = Patterns of care and outcome in elderly cervical cancer patients: A special focus on brachytherapy| journal = Radiotherapy and Oncology| volume = 91| issue = 2| pages = 197–201| year = 2009| pmid = 18954913 | doi = 10.1016/j.radonc.2008.08.011| last2 = Mancy| last3 = Chajon| last4 = Duvillard| last5 = Pautier| last6 = Castaigne| last7 = Lhommé| last8 = Morice| last9 = Haie-Meder}}</ref>
Transient increased bowel frequency, diarrhoea, constipation or minor rectal bleeding
Brachytherapy for skin cancer may result in a shedding of the outer layers of skin (desquamation) around the area of treatment in the weeks following therapy, which typically heals in 5–8 weeks.<ref name="GEC-ESTRO" />{{rp|Ch. 28}} If the cancer is located on the lip, ulceration may occur as a result of brachytherapy, but usually resolves after 4–6 weeks.<ref name="Casino-2006">
Line 172 ⟶ 173:
In a small number of people, brachytherapy may cause long-term side effects due to damage or disruption of adjacent tissues or organs. Long-term side effects are usually mild or moderate in nature. For example, urinary and digestive problems may persist as a result of brachytherapy for cervical or prostate cancer, and may require ongoing management.<ref name="Frank-2007" /><ref name="Doust-2004" /><ref name="Magné-2009" />
Brachytherapy for prostate cancer may cause erectile dysfunction in approximately
Brachytherapy for breast or skin cancer may cause scar tissue to form around the treatment area. In the case of breast brachytherapy, fat necrosis may occur as a result of fatty acids entering the breast tissues. This can cause the breast tissue to become swollen and tender. Fat necrosis is a benign condition and typically occurs 4–12 months after treatment and affects about 2% of patients.<ref name="Vicini-2009">
Line 183 ⟶ 184:
==Types==
Different types of brachytherapy can be defined according to (1) the [[Brachytherapy#Source placement|placement of the radiation sources]] in the target treatment area, (2) the [[Brachytherapy#Dose rate|rate or
===Source placement===
Line 194 ⟶ 195:
===Dose rate===
The dose rate of brachytherapy refers to the level or
▲The dose rate of brachytherapy refers to the level or ‘intensity’ with which the radiation is delivered to the surrounding medium and is expressed in [[Gray (unit)|Grays]] per hour (Gy/h).
Low-dose rate (LDR) brachytherapy involves implanting radiation sources that emit radiation at a rate of up to 2 Gy·h<sup>−1</sup>.<ref name="Thomadsen 2005">
{{Cite book | last = Thomadsen BR | year = 2005 | title = Brachytherapy Physics | publisher = Medical Physics Publishing | display-authors = etal }}</ref> LDR brachytherapy is commonly used for cancers of the oral cavity,<ref name="Mazaron-2009">
{{Cite journal | last1 = Mazeron | first1 = J. J. | last2 = Ardiet | first2 = J. M. | last3 = Haie-Méder | first3 = C. | last4 = Kovács | first4 = G. R. | last5 = Levendag | first5 = P. | last6 = Peiffert | first6 = D. | last7 = Polo | first7 = A. | last8 = Rovirosa | first8 = A. | last9 = Strnad | first9 = V. | doi = 10.1016/j.radonc.2009.01.005 | title = GEC-ESTRO recommendations for brachytherapy for head and neck squamous cell carcinomas | journal = Radiotherapy and Oncology | volume = 91 | issue = 2 | pages = 150–156 | year = 2009 | pmid = 19329209 }}</ref> [[oropharynx]],<ref name="Mazaron-2009" /> [[sarcomas]]<ref name="GEC-ESTRO" />{{rp|Ch. 27}} and [[prostate cancer]]<ref name="GEC-ESTRO" />{{rp|Ch. 20}}<ref name="Koukourakis-2009" >
{{Cite journal | author = Koukourakis G | year = 2009 | title = Brachytherapy for prostate cancer: A systematic review | journal = Adv Urol | volume = 26 | issue = 1 | pages =63–8 | pmid = 2735748 | display-authors = etal | doi = 10.1177/000456328902600109 | doi-access =
Medium-dose rate (MDR) brachytherapy is characterized by a medium rate of dose delivery, ranging between 2 Gy·h<sup>−1</sup> to 12 Gy·h<sup>−1</sup>.<ref name="Thomadsen 2005" />
High-dose rate (HDR) brachytherapy is when the rate of dose delivery exceeds 12 Gy·h<sup>−1</sup>.<ref name="Thomadsen 2005" /> The most common applications of HDR brachytherapy are in tumours of the [[cervix]], [[esophagus]], [[lungs]], [[breasts]] and [[prostate]].<ref name="GEC-ESTRO" /> Most HDR treatments are performed on an outpatient basis, but this is dependent on the treatment site.<ref name="Nag-2004">
{{Cite journal | author = Nag S. | year = 2004 | title = High dose rate brachytherapy: its clinical applications and treatment guidelines | journal = Technology in Cancer Research and Treatment | volume = 3 | issue = 3 | pages = 269–87 | pmid = 15161320 | doi = 10.1177/153303460400300305 | doi-access =
Pulsed-dose rate (PDR) brachytherapy involves short pulses of radiation, typically once an hour, to simulate the overall rate and effectiveness of LDR treatment. Typical tumour sites treated by PDR brachytherapy are gynaecological<ref name="GEC-ESTRO" />{{rp|Ch. 14}} and head and neck cancers.<ref name="Mazaron-2009" />
[[File:Radioactive seed dose calculation geometry.png|right|thumb|Dose calculation geometry]]
The calculation of radiation dose from radioactive seeds is crucial in the planning and administration of brachytherapy treatments. Most modern calculation are done using the formalism published by the [[American Association of Physicists in Medicine]].<ref>{{cite journal|last1=Nath|first1=R.|last2=Anderson|first2=L. L.|last3=Luxton|first3=G.|last4=Weaver|first4=K. A.|last5=Williamson|first5=J. F.|last6=Meigooni|first6=A. S.|title=Dosimetry of interstitial brachytherapy sources: Recommendations of the AAPM Radiation Therapy Committee Task Group N. 43.|journal=Medical Physics|date=1995|volume=22|issue=2|pages=209–234|doi=10.1118/1.597458|pmid=7565352|bibcode=1995MedPh..22..209N }}</ref> For the geometry in figure 1, this formalism uses five parameters.
*''Strength of the source'': How much radiation is being emitted by the seed, expressed as [[Kerma (physics)|air kerma strength]] and denoted by <math>S_k</math>.
*''Dose rate of the source'': How much dose the seed will deliver to the reference point over a certain period of time, denoted by <math>\Lambda</math>.
*''Geometry factor'': How the shape of the seed will affect the dose at points away from the reference point, denoted by <math>G(r,\theta)</math>.
*''Anisotropy function'': How the much radiation will be stopped before passing out of the seed, denoted by <math>F(r,\theta)</math>.
*''Radial dose function'': How the radiation will interact with the material surrounding the seed, denoted by <math>g(r)</math>.
The equation which links these parameters is, <math>D(r,\theta)=S_k \Lambda \frac{G(r,\theta)}{G(r_0,\theta_0)}g(r)F(r,\theta)t</math>
===Duration of dose delivery===
Line 220 ⟶ 229:
==Procedure==
[[File:Brachytherapy procedure flow.jpg|thumb|upright=1.75|Typical stages of a brachytherapy procedure
===Initial planning===
Line 227 ⟶ 236:
Using this information, a plan of the optimal distribution of the radiation sources can be developed. This includes consideration of how the source carriers (applicators), which are used to deliver the radiation to the treatment site, should be placed and positioned.<ref name="GEC-ESTRO" />{{rp|Ch. 5}} Applicators are non-radioactive and are typically needles or plastic catheters. The specific type of applicator used will depend on the type of cancer being treated and the characteristics of the target tumour.<ref name="GEC-ESTRO" />{{rp|Ch. 5}}
This initial planning helps to ensure that
===Insertion===
Line 235 ⟶ 244:
===Creation of a virtual patient===
[[File:Brachytherapy virtual patient.jpg|thumb
The images of the patient with the applicators in situ are imported into treatment planning software and the patient is brought into a dedicated shielded room for treatment. The treatment planning software enables multiple 2D images of the treatment site to be translated into a 3D
{{Clear}}
===Optimizing the irradiation plan===
[[File:Brachytherapy treatment planning.jpg|thumb|upright|Refinement of the treatment plan during a brachytherapy procedure
To identify the optimal spatial and temporal distribution of radiation sources within the applicators of the implanted tissue or cavity, the treatment planning software allows virtual radiation sources to be placed within the virtual patient. The software shows a graphical representation of the distribution of the irradiation. This serves as a guide for the brachytherapy team to refine the distribution of the sources and provide a treatment plan that is optimally tailored to the anatomy of each patient before actual delivery of the irradiation begins.<ref name="GYNOpt-2009">{{Cite journal | author = Trnková P. | author2 = Pötter R. | author3 = Baltas D. | author4 = Karabis A. | author5 = Fidarova E. | author6 = Dimopoulos J. | author7 = Georg D. | author8 = Kirisits C. | year = 2009 | title = New inverse planning technology for image-guided cervical cancer brachytherapy: Description and evaluation within a clinical frame | journal = Radiotherapy and Oncology | volume = 93 | issue = 2 | pages = 331–340 | pmid = 19846230 | url = http://www.pi-medical.gr/sites/default/files/New%20inverse%20planning%20technology%20for%20image-guided%20cervical%20cancer%20brachytherapy_1.pdf | doi = 10.1016/j.radonc.2009.10.004 | access-date = 2010-03-11 | archive-url = https://web.archive.org/web/20151017210629/http://www.pi-medical.gr/sites/default/files/New%20inverse%20planning%20technology%20for%20image-guided%20cervical%20cancer%20brachytherapy_1.pdf | archive-date = 2015-10-17 | url-status = dead }}</ref> This approach is sometimes called
===Treatment delivery===
The radiation sources used for brachytherapy are always enclosed within a non-radioactive capsule. The sources can be delivered manually, but are more commonly delivered through a technique known as
Manual delivery of brachytherapy is limited to a few LDR applications, due to risk of radiation exposure to clinical staff.<ref name="Flynn 2005" />
Line 251 ⟶ 260:
In contrast, afterloading involves the accurate positioning of non-radioactive applicators in the treatment site, which are subsequently loaded with the radiation sources. In manual afterloading, the source is delivered into the applicator by the operator.
Remote afterloading systems provide protection from radiation exposure to healthcare professionals by securing the radiation source in a shielded safe. Once the applicators are correctly positioned in the patient, they are connected to an
On completion of delivery of the radioactive sources, the applicators are carefully removed from the body. Patients typically recover quickly from the brachytherapy procedure, enabling it to often be performed on an outpatient basis.<ref name="Nag-2004" />
{{Clear}}
Between 2003 and 2012
==Radiation sources==
Commonly used radiation sources (radionuclides) for brachytherapy
{| class="wikitable"
|-
! Radionuclide
! Decay mode
! Half-life
! Energy
|-
| [[
| [[Electron
| 9.7 days
| 30.4 [[kiloelectronvolt|keV]] (mean)
|-
| [[
| [[Beta decay|β<sup>−</sup>
| 30.17 years
| 0.512, 0.662 [[megaelectronvolt|MeV]] γ-rays
|-
| [[Cobalt-60]] (<sup>60</sup>Co)
| β<sup>−</sup>
| 5.26 years
| 1.17, 1.33 MeV γ-rays
|-
| [[Iridium-192]] (<sup>192</sup>Ir)
| β<sup>−</sup>, ε, γ
| 73.8 days
| 0.38 MeV (mean)
|-
| [[Iodine-125]] (<sup>125</sup>I)
| ε
| 59.6 days
| 27.4, 31.4 and 35.5 keV
|-
| [[Palladium-103]] (<sup>103</sup>Pd)
| ε
| 17.0 days
| 21 keV (mean)
|-
| [[Ruthenium-106]] (<sup>106</sup>Ru)
| β<sup>−</sup>
| 1.02 years
| 3.54 MeV
|-
| [[Radium-226]] (<sup>226</sup>Ra)
| [[Alpha decay|α]]
| 1599 years
|}
Line 310 ⟶ 319:
==History==
Brachytherapy dates back to 1901 (shortly after the discovery of radioactivity by [[Henri Becquerel]] in 1896) when [[Pierre Curie]] suggested to [[Henri-Alexandre Danlos]] that a radioactive source could be inserted into a tumour.<ref name="Gupta-1995">
{{Cite journal | author = Gupta VK. | year = 1995 | title = Brachytherapy – past, present and future | journal = Journal of Medical Physics | volume = 20 | issue = 2 | pages = 31–38 | doi = 10.4103/0971-6203.50045 | doi-access = free }}</ref><ref name="Nag 2009">{{cite web | url = http://www.americanbrachytherapy.org/aboutBrachytherapy/history.cfm | title = A brief history of brachytherapy | access-date = 25 September 2009 | author = Nag S | archive-date = 22 December 2017 | archive-url = https://web.archive.org/web/20171222050622/https://www.americanbrachytherapy.org/aboutBrachytherapy/history.cfm | url-status = dead }}</ref>
It was found that the radiation caused the tumour to shrink.<ref name="Nag 2009" /> Independently, [[Alexander Graham Bell]] also suggested the use of radiation in this way.<ref name="Nag 2009"/> In the early twentieth century, techniques for the application of brachytherapy were pioneered at the Curie institute in Paris by Danlos and at St Luke's and Memorial Hospital in New York by [[Robert Abbe]].<ref name="GEC-ESTRO" />{{rp|Ch. 1}}<ref name="Nag 2009" />
Working with the Curies in their radium research laboratory at the University of Paris, American physicist [[William Duane (physicist)|William Duane]] refined a technique for extracting radon-222 gas from [[radium sulfate]] solutions. Solutions containing 1 gram of radium were "milked" to create radon "seeds" of about 20 millicuries each. These "seeds" were distributed throughout Paris for use in an early form of brachytherapy named endocurietherapy. Duane perfected this "milking" technique during his time in Paris and referred to the device as a "radium cow".<ref name=Coursey>{{cite journal |last1=Coursey |first1=Bert M. |title=150th Anniversary of the Birth of Marie Curie
Duane returned to the United States in 1913 and worked in a joint role as assistant professor of physics at Harvard and Research Fellow in Physics of the Harvard Cancer Commission.<ref>{{cite web |last1=Bridgman |first1=P.W. |title=Biographical Memoir of William Duane 1872-1935 |url=http://www.nasonline.org/publications/biographical-memoirs/memoir-pdfs/duane-william.pdf |website=www.nasonline.org |publisher=National Academy of Sciences |access-date=16 June 2021}}</ref> The Cancer Commission was founded in 1901 and hired Duane to investigate the usage of radium emanations in the treatment of cancer.<ref>{{cite journal |last1=Webster |first1=Edward W. |title=The origins of Medical Physics in the USA: William Duane, Ph.D., 1913-1920 |journal=Medical Physics |date=1993 |volume=20 |issue=6 |pages=1607–1610 |doi=10.1118/1.597159 |pmid=8309432 |bibcode=1993MedPh..20.1607W |url=http://www.uthgsbsmedphys.org/GS02-0093/Webster%201993%20manuscript%20about%20radon.pdf |access-date=16 June 2021 |archive-date=13 June 2021 |archive-url=https://web.archive.org/web/20210613132843/http://www.uthgsbsmedphys.org/GS02-0093/Webster%201993%20manuscript%20about%20radon.pdf |url-status=dead }}</ref> In 1915 he built Boston's first "radium cow" and thousands of patients were treated with the radon-222 generated from it.<ref>{{cite journal |last1=Brucer |first1=Marshall |title=William Duane and the radium cow: An American contribution to the emerging atomic age |journal=Medical Physics |date=November 1993 |volume=20 |issue=6 |pages=1601–1605 |doi=10.1118/1.596947 |pmid=8309431 |bibcode=1993MedPh..20.1601B |url=https://doi.org/10.1118/1.596947 |access-date=15 June 2021}}</ref>
Interstitial radium therapy was common in the 1930s.<ref name="GEC-ESTRO" />{{rp|Ch. 1}} Gold seeds filled with [[radon]] were used as early as 1942<ref>{{Cite journal | doi = 10.1001/archderm.1975.01630180085013 | last1 = Goldstein | first1 = N. | title = Radon seed implants. Residual radioactivity after 33 years | journal = Archives of Dermatology | volume = 111 | issue = 6 | pages = 757–759 | year = 1975 | pmid = 1137421}}</ref> until at least 1958.<ref>{{cite journal|last=Winston|first=P.|title=Carcinoma of the Trachea Treated by Radon Seed Implantation|journal=The Journal of Laryngology & Otology|date=June 1958|volume=72|issue=6|pages=496–499|doi=10.1017/S0022215100054232|pmid=13564019|s2cid=36790323 }}</ref> [[Gold]] shells were selected by Gino Failla around 1920 to shield [[beta ray]]s while passing [[gamma ray]]s.<ref>{{cite web|last=Oak Ridge Associated Universities|title=Seeds (ca. 1940s - 1960s)|url=https://www.orau.org/health-physics-museum/collection/brachytherapy/seeds.html|work=ORAU Museum of Radiation and Radioactivity|access-date=12 October 2021}}</ref> [[Cobalt]] needles were also used briefly after World War II.<ref name="GEC-ESTRO" />{{rp|Ch. 1}} Radon and cobalt were replaced by radioactive [[tantalum]] and gold, before [[iridium]] rose in prominence.<ref name="GEC-ESTRO" />{{rp|Ch. 1}} First used in 1958, iridium is the most commonly used artificial source for brachytherapy today.<ref name="GEC-ESTRO" />{{rp|Ch. 1}}
Following initial interest in brachytherapy in Europe and the US, its use declined in the middle of the twentieth century due to the problem of radiation exposure to operators from the manual application of the radioactive sources.<ref name="Nag 2009" /><ref name="Aronowitz-2008">
{{Cite journal| first1 = J.| title = The "Golden Age" of prostate brachytherapy: A cautionary tale| last1 = Aronowitz| journal = Brachytherapy| volume = 7| pages = 55–59| year = 2008 | doi = 10.1016/j.brachy.2007.12.004| pmid = 18299114| issue = 1}}</ref> However, the development of [[brachytherapy#Treatment delivery|remote afterloading systems]], which allow the radiation to be delivered from a shielded safe, and the use of new radioactive sources in the 1950s and 1960s, reduced the risk of unnecessary radiation exposure to the operator and patients.<ref name="Gupta-1995" /> This, together with more recent advancements in three-dimensional imaging modalities, computerised treatment planning systems and delivery equipment has made brachytherapy a safe and effective treatment for many types of cancer today.<ref name="GEC-ESTRO" />{{rp|Ch. 1}}
The word "brachytherapy" comes from the [[Ancient Greek|Greek]] word {{Lang-el|βραχύς
==Environmental hazard==
Due to the small size of brachytherapy sources and low control in early decades, there is a risk that some of these have escaped into the environment to become [[orphaned source]]s. A radium needle was found in a Prague playground in 2011, radiating 500
==See also==
Line 335 ⟶ 343:
* [[Nuclear medicine]]
* [[Intraoperative radiation therapy]]
* [[Radiation therapy#Contact
==References==
Line 341 ⟶ 349:
==External links==
{{
* [
{{Nuclear Technology}}
| |||