physics and clinical aspects of interstitial brachytherapy

PHYSICS AND CLINICAL ASPECTS OF INTERSTITIAL BRACHYTHERAPY PRESENTED BY Dr. Vimoj J. Nair Junior Resident Department of Radiation Oncology PGIMS, Rohtak, Harayana. Moderated By Dr. Vivek Kaushal Professor & Head DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA

INTERSTITIAL BRACHYTHERAPY
Mode of treatment where radioactive sources are directly implanted into tissues in and around the malignant growth.
Very high dose immediately surrounding the sources with rapid fall off outside.
DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA

INTERSTITIAL BRACHYTHERAPY RESIDENTS’ CONCEPT!!!! DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA OUCH!!!

GENERAL INDICATIONS OF INTERSTITIAL BRACHYTHERAPY
Primary Radical treatment
Well localized where adjacent LN involvement risk negligible
Implant boost after previous EBRT
Risk of adjacent LN inv+
Perioperative implant
At site risk of recurrence

CONTRAINDICATION
Target volume not identifiable/ margins indistinct
Tumor very extensive or with bone involvement
Poorly tolerated/ bone necrosis
Tumor access difficult

ISOTOPES USED FOR INTERSTITIAL BRACHYTHERAPY
Radium-226
Co 60
Cesium-137 [Cs 137 ]
Gold-198 [Au 198 ]
Iodine-125 [I 125 ]
Cesium -131 [Cs 131 ]
Iridium-192
Palladium-103 [Pd 103 ]
Samarium-145 [Sm 145 ]
Ytterbium-169
Californium-252 [Cf 252 ]

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Planning: Dose Rates (ICRU #38)
Low dose rate (LDR) - 0.4 to 2.0 Gy/hr
Medium dose rate (MDR) - 2 - 12 Gy/hr
High dose rate (HDR) - >12 Gy/hr

TYPE OF IMPLANTS
TEMPORARY IMPLANT:-
Short period of dose delivery
Sources removed after prescribed dose reached
PERMANENT IMPLANT :-
For less accessible sites
Dose delivered over lifetime of source until complete decay
Sources with short half life: 198-Au seeds ,125-I, 103-Pd seed for prostate implants

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA AL- ACTIVE LENGTH PL- PHYSICAL LENGTH When target Volume Involves skin & mucosa DIFFERENT TYPES OF SOURCES IN BRACHYTHERAPY

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Interstitial applicators- CATHETERS Interstitial applicators- NEEDLES

INTERSTITAL APPLICATORS DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA GUIDE-GUTTERS - hollow metallic needles consisting of 2 vertical limbs joined by a horizontal flange [First one loaded with hair pin] WIRE + HAIR PIN + CATH- ETHERS

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA TARGET VOLUME SPECIFICATION
Define target volume
Tumor plus margin
Organ plus risk margin
Tumor bed
Methods:
Orthogonal radiograph
CT Scan
MRI
Ultrasound
Surgical clips on margin

HOW TO SHOOT?? DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA SOURCE KEPT AT EQUAL DISTANCE FROM EACH OTHER! NO RULES!!! RESULT - BAD HOMOGENEITY!! HOW TO IMPLANT? INITIAL STRATEGY!! TUMOR RADIOACTIVE SOURCES

Manual methods
Manchester /Paterson-Parker system
Quimby systems
Memorial nomographs
Paris system
Computer methods
SYSTEMS OF INTERSTITIAL BRACHYTHERAPY DOSIMETRIC PLANNING DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA TEMPORARY INTERSTITIAL

Interstitial implant system consists of
Distribution rules
Dose specification and implant optimisation criteria
Dose calculation aids(tables etc)
DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA HOW TO PUT IMPLANTS WHERE & HOW TO PRESCRIBE DOSE OPTIMALLY

PATERSON-PARKER/ MANCHESTER SYSTEM
“ RADIUM ” dosage system to deliver uniform dose (within ±10%) to a plane or volume of interest
Sources distributed non-uniformly following certain rules, based on the size of the target volume, with more source strength concentrated in the periphery .
Pre-calculated tables gives cumulated source strength per unit dose (in mgh per 1000cGy) for given implant area or volume.
To obtain the total source strength, the table value is multiplied by the desired dose rate.

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Single, Double and Multiple Plane Implants SINGLE PLANE IMPLANTS - <1 cm thick
DOUBLE PLANE
1-2 cm thick
Required total source strength is equally divided between the two planes,
MULTIPLE PLANE - >2 cm thick ALSO VOLUME IMPLANTS

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA VOLUME IMPLANT [CUBE] VOLUME IMPLANT CYLINDER VOLUME IMPLANT SPHERE SINGLE PLANE IMPLANT DOUBLE PLANE IMPLANT

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Eg- FOR 4 X 4 IMPLANT ELONGATION CORRECTION

PATERSON-PARKER/ MANCHESTER SYSTEM [contd]
The dose derived from the table values is called the STATED DOSE
Stated dose is 10% larger than the minimum dose and 10% less than the maximum dose [ UNIFORMITY CRITERION] in the treatment region.
Treatment regions
PLANAR IMPLANTS
plane directly opposite the source plane at 0.5cm distance
VOLUME IMPLANTS
volume enclosed by peripheral sources in case of volume implants

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Arrangement of Needles for Planar Implants Shaded areas for dose calculations [implant volume] Active length crossed ends uncrossed ends

DISTRIBUTION RULES FOR PLANAR IMPLANTS
Radium amount in Periphery : Centre depends on implant size.
Needle Spacing not >1cm from each other or from the crossing ends
If implant ends are UNCROSSED , the effective area of dose uniformity is reduced 10% for each uncrossed end for table reading purposes.
If UNABLE to cross an end, increase implant size using longer needles to cover the tumor.
Multiple implant planes- the radium should be arranged as in rules 1-3 and planes should be parallel to each other.
DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA AREA ( Sq.CM ) ACTIVITY PERIPHERY INSIDE < 25 2 / 3 1 / 3 25 – 100 1 / 2 1 / 2 > 100 1 / 3 2 / 3

VOLUME IMPLANTS – DISTRIBUTION RULES
Total amount of radium divided into 8 parts and distributed as follows for various shapes [Sphere, cylinder, cube]
CYLINDER: belt , four parts; core , two parts, each end one part
SPHERE: shell , six parts; core , two parts
CUBE: each side , one part; core , two parts
Needles spaced as uniformly as possible, not >1 cm apart. There should be atleast 8 needles in belt and four in core.
Uncrossed ends – 7.5% is deducted from the volume for table reading purposes.
For a volume implant the prescribed dose is stated 10% higher than the minimum dose within the implanted volume.

CORRECTIONS TO BE MADE TO DOSE FROM PP TABLES FOR
EXPOSURE RATE CONSTANT ( г ); the tables assume 8.4Rcm2/mg-h instead of the current value of 8.25 cm2/mg-h
ROENTGEN:CGY FACTOR of 0.957 should be used to convert exposure into dose in muscle.
OBLIQUE FILTERATION: by the platinum capsule (2-4% error )
TISSUE ATTENUATION AND SCATTERING - PP tables are based on exposure in air.
Thus the mg-h/ 1000R in the original Paterson-Parker tables should be considered equivalent to mg-h/900cGy .

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA 1 cm spaced, Variable intensity sources non uniformly, more source strength in periphery . CROSSING NEEDLES WHEN REQUIRED UNIFORM DOSE DISTRIBUTION From TABLES – mg-h/900R 1 cm distance 0.66 & 0.33 mgRa/cm sources AREA( Sq.CM ) ACTIVITY PERIPHERY INSIDE. < 25 2 / 3 1 / 3 25 – 100 1 / 2 1 / 2 > 100 1 / 3 2 / 3

QUIMBY SYSTEM
Uses equally spaced , uniform strength sources distributed over a source plane or treatment volume.
Results in a nonuniform dose distribution, higher in the central region of treatment
Allowed higher source strength (1 mg/cm) compared to the Manchester System (0.66 & 0.33 mg/cm)
For planar implants, the QUIMBY TABLES give the mg-hr required to produce 1000R in the center of the treatment planes, up to 3cm distance from the plane of implant.
For PLANAR implants, the stated dose is thus the maximum dose in the plane of treatment.
For volume implants, the stated dose is the minimum dose within the implanted volume
Manchester data for QA in Quimby type implant geometries

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA 1 cm spaced , UNIFORM STRENGTH [1 MgRa/cm] SOURCES CROSSING NEEDLES WHEN REQUIRED NONUNIFORM DOSE DISTRIBUTION CENTRE HIGH From TABLES – mg-h/1000R PLANAR – STATED DOSE – MAX DOSE VOLUME – STATED DOSE – MIN DOSE

C. THE MEMORIAL SYSTEM (Laughlin et al)
Extension of Quimby system
Planning intra operative permanent volume implants of unresectable tumors
Characterized by computer generated dose distributions around lattices of point sources of uniform strength spaced 1cm apart.
Based on computer generated dose distributions, charts/Nomograms developed for different isotopes relating implant dimensions to the number of seeds, activity, and spacing that gave mg-hrs to deliver 1000 rads to a prescription point
These tables used proper exposure rate constant and include the effects of oblique filtration , elongation factor and tissue attenuation

PARIS SYSTEM (Pierquin et al)
Primarily for single & double plane implants
Especially removable/temporary implants of longer line sources, e.g 192 Ir wires.
GENERAL RULES
Sources must be linear, parallel placed, uniformly spaced, equal length, source strength/linear activity.
The centres of all sources must be located in the same plane (central plane)
Spacing between sources should be wider when using long sources.
Dose specification based on an reference (stated) isodose -fixed at 85% of “ basal dose ”
BASAL DOSE - average of the minimum dose between sources inside implanted volume
If the guidelines are followed, then the reference isodose surface should encompass the whole target volume.

Calculation of the basal dose rate [BD]: Planar (A, B) or curved surfaces (C). Basal doses calculated midway between each pair of sources and averaged. Calculation of the basal dose rate BD in triangles (A), in squares (B). Basal doses calculated equidistant from each of the adjacent sources.

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Paris System of dosimetry
X = Minimum dose = basal dose
Average of basal doses = mean basal dose [elementary BD]
Reference dose = 0.85 basal dose (closely approximates minimum peripheral dose)
To consider an implant satisfactory, each basal dose rate should be within ±10% of the Mean basal dose rate
X X X X X X X X X X X

UNACCEPTABLE IMPLANT SORRY!! THIS WAS MY FIRST IMPLANT, I’LL IMPROVE BEFORE YOUR TWO MORE SESSIONS ARE OVER! IMPLANTS WITH IMPERFECT GEOMETRY

ICRU RECOMMENDATIONS
PTV , CTV similar to EBRT. No margin needed for PTV
Treatment volume is tissue volume encompassed by the reference isodose; ideally around CTV.
Reported doses defined in the central plane as in the Paris system, and renamed
basal dose to Mean Central Dose (MCD)
Reference dose to Minimum Target dose (MTD)
Two uniformity parameters
Spread in the individual minimum doses averaged to get the mean
Ratio of the minimum target dose to the mean central dose. [MTD:MCD]
International Commission on Radiological Units. Dose and Volume Specification for Reporting Interstitial Therapy. Report No 58. Washington DC: ICRU Publications, 1997

COMPUTER SYSTEM
Uniform strength sources, spaced uniformly (Eg: 1.0-1.5 cm, with larger spacing for larger size implants) and covering entire target volume.
Similar to Paris and Quimby; implant that is “ hotter “ in the middle than in periphery.
This dose inhomogeneity accepted – more dose needed in centre to sterilize the tumor
Safety margins for target volume - peripheral sources placed at target boundary with adequate coverage of tumor.
DOSE SPECIFIED by the isodose surface that just surrounds the target or implant.
NO CROSSING SOURCES - active length of the line sources should be suitably longer (=40% longer) than the length of the target volume

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA RULES OF INTERSTITIAL IMPLANT SYSTEMS CHARACTERISTIC PATERSON-PARKER QUIMBY PARIS COMPUTER LINEAR STRENGTH VARIABLE (full intensity, 0.66 mgRa/cm; half intensity,0.33 mgRa/cm) CONSTANT (full intensity, 1mg Ra/cm; half intensity, 0.5 mgRa/cm) CONSTANT (0.6-1.8 mg Ra eq/ cm) CONSTANT (0.2-0.4 mg Ra eq/cm) SOURCE DISTRIBUTION PLANAR IMPLANTS (in periphery) Area <25cm 2 - 2/3 Ra Area 25-100cm 2 - 1/2 Ra Area >100cm 2 - 1/3 Ra UNIFORM UNIFORM UNIFORM VOLUME IMPLANTS CYLINDER: belt , four parts; core , two parts, each end one part SPHERE: shell , six parts; core , two parts CUBE: each side , one part; core , two parts UNIFORM distribution of sources throughout the volume Line sources arranged in parallel Line source arranged in parallel planes or cylindric volumes LINE SOURCE SPACING CONSTANT Approximately 1cm apart from each other or from crossing ends Same as Paterson-Parker CONSTANT [according to implant dimensions - larger spacing used in large volumes;8mm min to 15mm max separation CONSTANT 1-1.5cm, depending on size of implant (larger spacing for larger size implants) CROSSING NEEDLES Crossing needles required to enhance dose at implant ends Same as Paterson-Parker Crossing needles NOT used, active length 30%-40% longer than target length Crossing needles NOT used, active length of sources 30-40% larger than target length

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Plan Description/Documentation
Interstitial
Permanent / Removable
Air-Kerma strengths
Source type / model
Type of template / applicator
Single / double / multiple plane
Optimization of source strength/position
Computer reference data (1-D. 2-D or 3-D)
Prescribed dose/dose rate/ treatment duration
Dose to critical points
Ensure compliance with all local & national regulations

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Sites Implanted by Brachytherapy
Uncommon Sites:
Eye – Uveal melanoma
Brain
Bladder
Urethra
Sarcomas
Endometrium
Penis
Vagina
Anorectal
Common Sites
Prostate
Cervix
Head & Neck
Breast
Skin

INTERSTITIAL BRACHYTHERAPY IN HEAD AND NECK CANCERS
CA TONGUE
CA FLOOR OF MOUTH
LIP
CHEEK/BUCCAL MUCOSA
NASAL VESTIBULE
OROPHARNX
SKIN CANCERS
SECONDARY NECK
DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA RADICAL DOSE: 60-70Gy BOOST DOSE TO PRIMARY: 20-30Gy; 2-3 wks after completion of EBRT

CANCER OF TONGUE
Those on lateral border of the anterior two-third of the tongue.
<3cm diameter
Well differentiated
Radical ISBT 60-70Gy
If larger/ poorly differentiated
BOOST primary with 20-30Gy; 2-3 wks after completion of EBRT

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Interstitial implants - tongue implant tongue tongue Catheter loop Button

CA OROPHARYNX
SCCs of base of tongue, the soft palate, the tonsillar fossa, and the vallecula less than 50 mm in diameter
CONTRAINDICATION
Primary extends to retromolar trigone, nasopharynx, larynx, hypopharynx, or invades bone.
Associated with bulky cervical lymph nodes.
# <6Gy between 6hours or more

CANCER OF FLOOR OF MOUTH
Indications – similar to tongue lesions
If bone fixation – risk of osteoradionecrosis
Risk of necrosis higher than for tongue.

Cancer of Lip
Esp >1/3 rd of lip
Sx not practical -Extensive plastic surgery
Post RT recurrence salvage

CANCER OF CHEEK/BUCCAL MUCOSA
Single plane implant

SKIN CANCER
epidermal skin cancers T1 - T2 N0 on the face
Post EBRT Boost in larger tumourS
Similar cure rate – but needs hospital admission
DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Hypodermic needles for Skin ISBT

Ca PENIS
Radical dose – 56-60 Gy
CONTRAINDICATION
Infiltration of corpora cavernosa
Greater than 4cm in any dimension
DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Pierquin-Chassagne applicator

BREAST CANCER
INDICATION
In BCT-Post lumpectomy site boost after EBRT
boost to the tumor residue after EBRT for inoperable disease
salvage therapy for local recurence
sole method of radiation following lumpectomy
DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Further reading & Guidelines : Oncology, Vol. 15, No. 2 (February 2001).

DOSE FOR BREAST INTERSTITIAL BRACHYTHERAPY
POST EBRT+ POST Complete Resection
Dose of 15 Gy
After incomplete resection
20-25 Gy
HDR - 10Gy in 1 fraction or doses up to 20 Gy in 4 to 6 Gy fractions.

INTERSITIAL BRACHYTHERAPY IN PELVIS
COMMON SITES
Cervix
Anal canal
Prostate
Vagina
RARE SITES
Urinary bladder
Vulva
Urethra
Endometrium

Indications of interstitial implantation in carcinoma cervix
Extensive residual disease(not likely to be taken care of by intracavitary application)
Os not negotiable
Extensive parametrial involvement
Recurrent disease(post RT/post surgery)
Narrow vagina
DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Further reading on practice guidelines - International Journal of Radiation Oncology Biology Physics , Vol. 48, No.1, pp 201-211, 2000, and Vol. 52, No. 1, pp 33-48, 2002.

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA MUPIT ( Martinez Universal Perineal Interstitial Template) GUIDE HOLES

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Syed Neblett template

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA

CANCER OF VAGINA
Limited superficial lesions
radical implant
Advanced stages
EBRT f/b boost to primary using implant

CA ENDOMETRIUM
NOT COMMONLY DONE
DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA the International Journal of Radiation Oncology Biology Physics, Vol. 48, No. 3, pp 779-790, 2000.

Anorectal Cancers
Indication
Post EBRT local boost.
Disease recurrence post radiotherapy
Palliative role (If elderly advanced and APR not feasible for medical reasons 40 Gy EBRT F/B IMPLANT)
Not to implant > 60-70% of the circumference of the anal canal
AFTER 30-40 Gy, tumor implanted in 6-8 wks. Boost dose to primary is 20-30Gy.
Results comparable to radical surgery

TUMOURS OF THE URETHRA
Rarely performed
INDICATIONS
Primary tumors of urethra
Boost after EBRT

Bladder cancer
Not done now
After cystotomy, Superficial part resected and plastic tubes inserted into base
2000-3000cGy + EBRT to pelvis at dose of 45-50Gy

Indications for brachytherapy in carcinoma prostate
Early stage disease as a sole modality
As boost after external beam radiotherapy
In cases of recurrent disease
BOTH PERMANENT & TEMPORARY IMPLANTS

Indication for prostate brachytherapy monotherapy DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA IPSS: International Prostate Symptom Score. Q max ml/s: urinary flow rate. Ash D, Flynn A, Battermann J. ESTRO/EAU Urological Brachytherapy Group; EORTC Radiotherapy Group. ESTRO/EAU/EORTC recommendations on permanent seed implantation for localized prostate cancer. Radiother Oncol 2000;57:315 — 21. Recommended Do well Optional Fair PSA (ng/ml) <10 10 — 20 Gleason score 5 — 6 7 Stage T1c — T2a T2b — T2c IPSS 0 — 8 9 — 19 Prostate volume (g) <40 40 — 60 Q max ml/s >15 10-15

CONTRA-INDICATIONS TO PERMANENT SEED IMPLANTS
Life expectancy less than 5 years.
The presence of metastatic disease.
Recent TURP with persisting large prostatic defect.
Bleeding disorders; patients on regular Aspirin/or anticoagulants should stop it at least seven days before implantation.
Prostate gland of greater than 50 ccs
DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Further reading :International Journal of Radiation Oncology Biology Physics, Vol. 1, No. 5, pp 1422-1430, 2001.

BRACHYTHERAPY DOSE CA PROSTATE
125 Iodine - 145 Gy
Post EBRT boost - 95 to 100 Gy.
103 Paladium
115 Gy [brachytherapy alone]
Post EBRT Boost-90 Gy
DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA American brachytherapy society (ABS) recommendations for transperineal permanent brachytherapy of prostate cancer

Episcleral plaque Brachytherapy of uveal melanomas.
INDICATION
Non-metastatic Medium-sized choroidal melanoma (between 2.5 and 10 mm in height and <16 mm basal diameter)
Dose[ABS]
125 I dose of 85 Gy at a dose rate of 0.60-1.05 Gy/h
DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Nag S, Quivey JM, Earle JD, Followill D, Fontanesi J, Finger PT; American Brachytherapy Society. The American Brachytherapy Society recommendations for brachytherapy of uveal melanomas. Int J Radiat Oncol Biol Phys. 2003 Jun 1;56(2):544-55.

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA INTERSTITIAL BRACHYTHERAPY SITES LIVER METASTASIS / PERMANENT

BRAIN TUMORS
indicated in recurrent tumors
50 - 60 Gy

used alone or in combination with EBRT
Brachy alone 65-70Gy
ABS Recommendation for intraoperative HDR brachytherapy
Doses 10-15 Gy (prescribed at a 0.5 cm depth of this brachytherapy is used as a boost to EBRT
SOFT TISSUE SARCOMA Further Reading -International Journal of Radiation Oncology Biology Physics, Vol. 49, No. 4, pp 1033-1043, 2001.

DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA THANK YOU ALL

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physics and clinical aspects of interstitial brachytherapy

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physics and clinical aspects of interstitial brachytherapy Presentation Transcript