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Medical and Biological Applications of Low Energy Accelerators
Published in Vlado Valković, Low Energy Particle Accelerator-Based Technologies and Their Applications, 2022
Brachytherapy is a key component of radiation treatment for gynecological cancers. Other indications for brachytherapy include: prostate, breast, soft tissue sarcomas, some head and neck tumors and skin cancers (see IAEA 2017, IAEA 2015b, IAEA 2015c). For cervical and skin cancers, it has become a standard therapy for more than 100 years as well as an important part of the treatment guidelines for other malignancies, including head and neck, skin, breast and prostate cancers.
Brachytherapy Dosimetry
Published in Arash Darafsheh, Radiation Therapy Dosimetry: A Practical Handbook, 2021
Christopher L. Deufel, Wesley S. Culberson, Mark J. Rivard, Firas Mourtada
Radiotherapy can be delivered using external beam or brachytherapy. The main advantage of brachytherapy is the close proximity of the radiation source to the target (tumor or benign), when this option is viable. Delivery options include interstitial, intracavitary, endoluminal, intraoperative, or surface (i.e., plesiotherapy). Brachytherapy has a long history since the early 1900s and the most recent decade has exploded with new radiation sources, advanced image-guided treatment planning, and improved delivery devices. Cancers of the cervix, prostate, breast, and skin have been most commonly cured using brachytherapy as monotherapy or as a boost to external beam radiotherapy (EBRT) [1–5]. Other disease sites have also benefited from this special radiotherapy modality such as ocular melanoma, endorectal, nasopharynx, lung cancer, and keloids [6–9]. Hence, brachytherapy advancements have enhanced its essential role for the treatment of malignant and nonmalignant disease with radiation. The radiation-emitting sources used for this treatment modality are radionuclide- or electronic-based and may incorporate low (<2 Gy h−1) or high (>1 Gy min−1) dose rates.
Oncology
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
Brachytherapy can also be given in the form of radioactive needles or implants inserted into the tumour. This can be done in the mouth or prostate and the implant may be either temporary (removed after 4–5 days) or left in place to gradually decay over years. The advantage of brachytherapy is that by placing the source of the radiation very close to the tumour bed, a much higher proportion of the radiation will be given to the tumour than to the surrounding tissues. When radiation is given from a linear accelerator, which is at a distance from the patient, it is more difficult to irradiate just the tumour bed without also involving surrounding structures in the radiotherapy dose.
Treatment of cervical cancer: overcoming challenges in access to brachytherapy
Published in Expert Review of Anticancer Therapy, 2022
Katie Lichter, Chidinma Anakwenze Akinfenwa, Emily MacDuffie, Rohini Bhatia, Christina Small, Jennifer Croke, William Small, Junzo Chino, Daniel Petereit, Surbhi Grover
Unfortunately, brachytherapy has been underutilized both in the United States (U.S.) and internationally due to several factors: limited exposure to the procedure during residency training, difficulty in maintenance of skills, lack of supportive infrastructure, low-volume treatment centers, alternative boost practices, limitations in advanced imaging techniques, preference for noninvasive techniques, and financial restraints and disincentives [4,10–14]. Graduating residents report lack of confidence and comfort in performing brachytherapy procedures independently, and specialized training, such as a fellowship in brachytherapy, is sometimes required [15]. Between 1988 and 2011, it is estimated that brachytherapy utilization for patients with cervical cancer in the U.S. has decreased by 11–25% [4,16]. Additionally, significant disparity among brachytherapy utilization for cervical cancer exists within different socioeconomic and ethnoracial groups within the same country [17]. In this review, we aim to explore current brachytherapy utilization practices and future initiative to improve brachytherapy access from the perspective of both low- and middle-income countries and high-income countries.
Stereotactic Body Radiation Therapy (SBRT) in Pelvic Lymph Node Oligometastases
Published in Cancer Investigation, 2020
Leonid B. Reshko, Martin K. Richardson, Kelly Spencer, Charles R. Kersh
For patients who are not good surgical candidates or who desire a less invasive approach, radiotherapy may offer another option. Treating pelvic lymph node metastases with radiotherapy presents a unique challenge in a setting of oligometastatic disease. In this location, avoiding radiation toxicities including cystitis, proctitis, colitis, bowel perforation, fistula formation, pelvic insufficiency fractures, and chronic pain is important (8,9). Conventionally fractioned radiotherapy has a well-recognized role in managing pelvic pain, hematuria, and obstruction from pelvic metastases not amenable to surgery (4–6). However, this approach is unlikely to provide durable disease control (10). Brachytherapy is another radiation treatment technique that allows for delivering a higher dose of radiation to the tumor directly with the goal of sparing normal tissues. This has been successfully used in recurrent pelvic tumors (11). The downside of this approach is the need for general anesthesia, the invasive nature of the procedure and the unique toxicity profile (11).
Prognostic Nutritional Index and Clinical Response in Locally Advanced Cervical Cancer
Published in Nutrition and Cancer, 2020
This study included 583 women from two cancer centers presenting with histologically proven locally advanced cervical cancer (FIGO stages IIB- IVA) between February 2007 and January 2014. During assessment at baseline, each patient underwent routine investigations and the PNI was calculated from the results of the baseline blood tests. In addition to the baseline PNI, the histology, the baseline hemoglobin levels, tumor stage, and the presence of pelvic inflammatory disease at the first visit were recorded in every case. In view of the known association between nutrition and immune balance, the neutrophil lymphocyte ratio (NLR), widely used as a marker of inflammatory status, was calculated at baseline for each subject. The women in this cohort received pelvic chemoradiation to a dose of 50 Gy in 25 fractions over 5 weeks, with weekly concomitant Cisplatin at a dose of 40 mg/m2. The treatment was completed after the conclusion of subsequent brachytherapy. Tumor response was assessed clinically by gynaecological examination at 6 weeks after treatment completion. The duration between the completion of chemoradiation, and the first fraction of brachytherapy, ranged between 7 and 12 day. Clinical response was considered to be complete if there was no evidence of tumor on speculum inspection and bimanual examination.