1. Introduction to Brachytherapy

2. Presentation Overview
What is Cancer?
Principles of Radiation Oncology
Introduction to Brachytherapy
Typical Treatment Process
Q & A

3. What is Cancer ? Cancer is related to: Growth Differentiation
Tissue integrity

4. Metastasis TUMOR- cells CARCINOMA IN SITU INVASIE DYSPLASIE
INTERVASATIE
HYPERPLASIE
TRANSPORT
INTERVASATIE
TRANSPORT
TRANSPORT
Metastasis
AANHECHTING
EXTRAVASATIE
EXTRAVASATIE
Healthy
cells
organ 2
Blood vessel
organ 1
Capillary

5. Cancer Treatment Options
SURGERY
CHEMOTHERAPY
BRACHYTHERAPY
HORMONE-THERAPY
RADIOTHERAPY
IMMUNOTHERAPY

6. 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

7. with Ionizing Radiation
Cell Sterilization
with Ionizing Radiation
Particle
Electron microscope image of multiplying cells
Cell Nucleus
cell
Chromosome

8. Why Brachytherapy? Cancer Brachytherapy End result Alternative:
Surgery

9. 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

10. Why Brachytherapy? 3-Fields External Beam AP-PA External Beam
Highly conformal

11. Conformal Brachytherapy
Treat only tumor tissue
Spare healthy tissue
One Source ...
Any Isodose Shape !!
Dose is determined by:
Source Strength
Exposure Time
Source Position

12. 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

13. 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

14. 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)
thyroid = schildklier

15. Treatments by Type of Loading
Manual “hot” loading
Manual Afterloading
Remote Afterloading

16. Brachytherapy Remote Afterloading Methods
Low Dose Rate Cesium pellets or Iridium wires, treatment 1-3 days
High Dose Rate Cobalt-60 pellets, Iridium Ci source, treatment in minutes
Pulsed Dose Rate Iridium Ci source, treatment 1-3 days

17. Afterloader: Low Dose Rate (LDR)
Cesium spheres and Iridium wires
no real optimization possible
long treatment times (days)
well known radiobiological and late effects
No real optimisation or conformal therapy possible: because source strenght of each pellet the same and Pellets remain there the same time. Only positioning can be influenced..
Low Dose Rate
Dates back to the days of Marie Curie (1900)
Nowadays uses Cesium spheres of the same activity or Iridium wires cut to required length.
No real optimisation or conformal therapy possible
Long treatment times
Continuous irradiation
Well known radiobiological and late effect
1978

18. 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)
High Dose Rate
Old systems using Cobalt-60 spheres
mHDR using miniature Iridium 192 source
No limitation to bodysites and curvatures
Stepping source
Optimisation/conformal therapy possible
Short treatment times (minutes) on outpatient basis
Fractionated treatments
Requires lot of shielding (bunker)
present

19. Afterloader: Pulsed Dose Rate (PDR)
stepping Iridium source ( Ci)
no limitation to body sites and curvatures
optimization possible
short radiation times (minutes)
long treatment times (days)
requires less shielding
present

20. Brachytherapy Components
Planning Systems
Remote Afterloaders
Body-site Specific Applicators
Imaging
devices

21. 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)

22. Synergy with Brachytherapy
Brachytherapy – External beam
Brachytherapy – Surgery
Per-operative
Pre-operative (improves surgical outcome)
Brachytherapy – Chemotherapy
Brachytherapy - Hyperthermia

23. 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

24. History of Radiation Oncology & Brachytherapy
Question & Answers