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Introduction to Brachytherapy

Introduction to Brachytherapy. Presentation Overview. What is Cancer? Principles of Radiation Oncology Introduction to Brachytherapy Typical Treatment Process Q & A. Growth. Differentiation. Tissue integrity. What is Cancer ?. Cancer is related to:. TUMOR- cells. CARCINOMA

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Introduction to Brachytherapy

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  1. Introduction to Brachytherapy

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

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

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

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

  6. Principles of Radiation Oncology • Damaging cells with radiation until cell repair is not possible anymore • Repair possibility of “normal” tissue is higherthan of tumor cells

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

  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 Brachytherapy 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)

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

  16. Brachytherapy Remote Afterloading Methods • Low Dose RateCesium pellets or Iridium wires, treatment 1-3 days • High Dose RateCobalt-60 pellets, Iridium-192 10 Ci source, treatment in minutes • Pulsed Dose RateIridium-192 1 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 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) 1986 - present

  19. 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

  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

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