• Title, Summary, Keyword: brachytherapy

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Brachytherapy in the Treatment of Head and Neck Cancer (근접방사선조사에 의한 두경부암의 치료)

  • Yoo, Seong-Yul
    • Radiation Oncology Journal
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    • v.17 no.3
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    • pp.179-187
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    • 1999
  • Brachytherapy has been proved to be an effective method for the purpose of increasing radiation dose to the tumor and reducing the dose to the surrounding normal tissue. In head and neck cancer, the rationale of brachytherapy is as follows; Firstly, early small lesion is radiocurative and the major cause of failure is local recurrence. Seondly, it can diminish evidently the dose to the normal tissue especially masseteric muscle and salivary gland. Thirdly, the anatomy of head and neck is suitable to various technique of brachytherapy. On background of accumulated experience of LDR iridium brachytherapy of head and neck cancer for the last 15 years, the author reviewed the history of radioisotope therapy, the characteristics of radionuclides, and some important things in the method, clinical technique and treatment planning. The author analyzed the clinical result of 185 cases of head and neck cancer treated in the Korea Cancer Center Hospital. Finally the future prospect of brachytherapy of head and neck cancer is discussed.

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Brachytherapy for Head and Neck Cancer (두경부암의 근접방사선 치료)

  • Yoo Seong-Yul
    • Korean Journal of Head & Neck Oncology
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    • v.7 no.1
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    • pp.3-9
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    • 1991
  • Brachytherapy is a method of radiotherapy in advantage to achieve better local control with minimum radiation toxicity in comparison with external irradiation because radiation dose is distributed according to the inverse square low of gamma-ray emitted from the implanted sources. The main characteristics of brachytherapy are delivering of higher dose to target volume shortening of total treatment period and sparing of normal tissue. Recent development of iridium ribbons for low dose rate implant provides improvement of technology of brachytherapy in terms of safety and efficiency. High dose rate method. on the other hand, is effective to avoid unnecessary expoure of medical personnel.

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Current Status of High Dose Rate Brachytherapy in Cervical Cancer in Korea and Optimal Treatment Schedule (자궁 경부암 고선량율 강내조사 치료의 국내 현황과 적정 치료방법)

  • Huh, Seung-Jae
    • Radiation Oncology Journal
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    • v.16 no.4
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    • pp.357-366
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    • 1998
  • Brachytherapy is an essential part of radiotherapy for uterine cervical cancer. The low dose rate (LDR) regimen has been the major technique of intracavitary therapy for cervical cancer. However, there has been an expansion in the last 20 years of high dose rate (HDR) machines using Ir-192 sources. Since 1979, HDR brachytherapy has been used for the treatment of uterine cervical cancer in Korea. The number of institutions employing HDR has been increasing, while the number of low dose rate system has been constant. In 1995, there was a total 27 HDR brachytherapy units installed and 1258 cases of patients with cervical cancer were treated with HDR Most common regimens of HDR brachytherapy are total dose of 30-39 Gy at point A with 10-13 fractions in three fractions per week. 24-32 Gy with 6-8 fractions in two fractions per week, and 30-35 Gy with 6-7 fractions in two fractions per week. The average fractionation regimen of HDR brachytherapy is about 8 fractions of 4.1 Gy each to Point A. In Korea, treatment results for HDR brachytherapy are comparable with the LDR series and appears to be a safe and effective alternative to LDR therapy for the treatment of cervical carcinoma. Studies from the major centers report the five-year survival rate of cervical cancer as. 78-86$\%$ for Stage 1, 68-85$\%$ for stage 11, and 38-56$\%$ for Stage III. World-wide questionnaire study and Japanese questionnaire survey of multiple institutions showed no survival difference in any stages and dose-rate effect ratio (HDR/LDR) was calculated to be 0.54 to 0.58. However the optimum treatment doses and fractionation schemes appropriate to generate clinical results comparable to conventional LDR schemes have yet to be standardized. In conclusion, HDR intracavitary radiotherapy is increasingly practiced in Korea and an effective treatment modality for cervical cancer. To determine the optimum radiotherapy dose and fractionation schedule, a nation-wide prospective study is necessary in Korea. In addition, standardization of HDR application (clinical, computer algorithms, and dosimetric aspects) is necessary.

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Brachytherapy in Coronary Artery Disease (관상동맥질환의 방사성동위원소 치료)

  • Song, Ho-Chun
    • Nuclear Medicine and Molecular Imaging
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    • v.40 no.2
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    • pp.113-119
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    • 2006
  • Coronary artery disease is a loading cause of morbidity and mortality across the world. Percutaneous coronary intervention has become the major technique of revascularization. However, restenosis remains a major limitation of this procedure. Recently the need for repeat intervention due to restenosis, the most vexing long-term failure of percutaneous coronary intervention, has been significantly reduced owing to the introduction of two major advances, intracoronary brachytherapy and the drug-eluting stents. Intracoronary brachytherapy has been employed in recent years to prevent restenosis lesions with effective results, principally in in-stent restenosis. Restenosis is generally considered as au excessive form of normal wound healing divided up in precesses: elastic recoil, neointimal hyperplasia, and negative vascular remodeling. Restenosis has previously been regarded as a proliferative process in which neointimal thickening, mediated by a cascade of inflammatory mediators and other factors, is the key factor. Ionizing radiation has been shown to decrease the proliferative response to injury in animal models of restenosis. Subsequently, several randomized, double blind trials have demonstrated that intracoronary brachytherapy can reduce the rates of both angiographic restenosis and clinical event rates in patients undergoing percutaneous coronary intervention for in stent restenosis. Some problems, such as late thrombosis and edge restenosis, have been identified as limiting factors of this technique. Brachytherapy is a promising method of preventing and treating coronary artery restenosis.

HIGH DOSE RATE BRACHYTHERAPY IN PRIMARY AND RECURRENT TONGUE CANCER (고선량율 근접 방사선치료법을 이용한 원발성 및 재발된 설암의 치료)

  • Lee, Ui-Lyong;Lee, Jong-Ho;Choung, Pill-Hoon;Kim, Myung-Jin;Park, Joo-Yong;Choi, Sung-Weon;Cho, Kwan-Ho
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.28 no.5
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    • pp.470-476
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    • 2006
  • Low-dose rate brachytherapy(LDR) has been effective modality for treatment of oral cancer. But the disadvantage of LDR is radioexposure of medical staff. To overcome this problem, high dose rate(HDR) brachytherapy has been developed. Our study evaluates the outcomes of patients with tongue cancer as treated by HDR brachytherapy. Between 2002 and 2005, eight patients with carcinoma of the tongue were treated with HDR brachytherapy. Five patients had AJCC stage I or II disease and the remaining three patients had AJCC stage III or IV. The male-to-female ratio was 2:6 and the mean age was 60.1 years (range: 21-80 years).The median follow-up time was 23.8 months (range: 7-55 months). There was no local failure until now. Three patients showed some complications. Two patients showed soft tissue necrosis. There was no bone sequela in all cases. Our experience in treating tongue cancer with HDR brachytherapy is encouraging, because it gave a satisfactory local control. Prospective studies are necessary to delineate the optimum indication for this treatment modality and long-term outcome.

Brachytherapy of Uveal Melanomas with Ruthenium-106 Plaques

  • Belaid, Asma;Nasr, Chiraz;Jmour, Omar;Cherif, Aziz;Kochbati, Lotfi;Bouguila, Hedi;Besbes, Mounir;Benna, Farouk
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.12
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    • pp.5281-5285
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    • 2016
  • Background: Brachytherapy is the most commonly used conservative treatment for the uveal melanoma. The aim of this study was to evaluate therapeutic results of Ruthenium-106 plaque brachytherapy in the management of localized uveal melanoma cases. Methods: We reviewed retrospectively the clinical records of all patients treated in our department for an uveal melanoma, undergoing Ruthenium-106 plaque brachytherapy, from January 1996 to December 2015. We focused on clinical features, therapeutic characteristics, local and distant tumor control and side effects. Results: Nineteen patients were enrolled in our study. Mean age was 56.2 years (28-79) and the sex ratio was 1.37:1 males to females. Diagnosis was made on the basis of ophthalmological clinical examination, angiography, ultrasound and/or magnetic resonance. Median tumor diameter was 9.7 mm (6-13) and median thickness 4.4 mm (2.5-8). The dose of Ruthenium-106 plaque brachytherapy prescribed to the apex of each tumor was 70 Gy in all cases. The median radiation dose to the sclera surface was 226.4 Gy (range: 179.6-342.3) and the median total application time 115.2 hours (range: 27 to 237). After a median follow-up of 61.5 months, local control was achieved in 17 patients (89%): 16 demonstrated a partial tumor response and 1 tumor stabilization. Two patients suffered local progression leading to enucleation, one dying of hepatic metastasis. Radiation-induced complications were cataracts in 3 cases and vitreal hemorrhage in 2. Conclusion: Ruthenium-106 plaque brachytherapy is an efficient treatment for localized uveal melanoma, offering good local control with low toxicity.

High Dose Rate Brachytherapy in Two 9 Gy Fractions in the Treatment of Locally Advanced Cervical Cancer - a South Indian Institutional Experience

  • Ghosh, Saptarshi;Rao, Pamidimukkala Bramhananda;Kotne, Sivasankar
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.16
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    • pp.7167-7170
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    • 2015
  • Background: Although 3D image based brachytherapy is currently the standard of treatment in cervical cancer, most of the centres in developing countries still practice orthogonal intracavitary brachytherapy due to financial constraints. The quest for optimum dose and fractionation schedule in high dose rate (HDR) intracavitary brachytherapy (ICBT) is still ongoing. While the American Brachytherapy Society recommends four to eight fractions of each less than 7.5 Gy, there are some studies demonstrating similar efficacy and comparable toxicity with higher doses per fraction. Objective: To assess the treatment efficacy and late complications of HDR ICBT with 9 Gy per fraction in two fractions. Materials and Methods: This is a prospective institutional study in Southern India carried on from $1^{st}$ June 2012 to $31^{st}$ July 2014. In this period, 76 patients of cervical cancer satisfying our inclusion criteria were treated with concurrent chemo-radiation following ICBT with 9 Gy per fraction in two fractions, five to seven days apart. Results: The median follow-up period in the study was 24 months (range 10.6 - 31.2 months). The 2 year actuarial local control rate, disease-free survival and overall survival were 88.1%, 84.2% and 81.8% respectively. Although 38.2% patients suffered from late toxicity, only 3 patients had grade III late toxicity. Conclusions: In our experience, HDR brachytherapy with 9 Gy per fraction in two fractions is an effective dose fractionation for the treatment of cervical cancer with acceptable toxicity.

Quality Assurance for High Dose Rate Brachytherapy (고선량율 근접치료의 정도관리)

  • Bang, Dong-Wan;Cho, Chung-Hee;Park, Jae-Il
    • The Journal of Korean Society for Radiation Therapy
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    • v.10 no.1
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    • pp.30-44
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    • 1998
  • Accurate delivery of doses using a high dose rate(HDR) brachytherapy, remote afterloading system(RALS) depends on knowing the strength of the radioactive source at the time of treatment, the precision and consistency of the timer, and the ability of the unit to position the source at the proper dwell location along the applicator. Periodic Quality Assurance(QA) on HDR machines is a part of the standard protocol of any user. The safety of the patient & staff, positional accuracy, temporal accuracy, and dose delivery accuracy are periodically(weekly, quarterly, monthly) estimated using HDR source(Ir-192), treatment planning devices, measurement devices, and overall treatment devices with regard to treatment delivery. The overall measurement results are estimated successfully and assessed its clinical significance. As a result, our HDR brachytherapy units has been very accurate until now. The QA program protocol permits routine clinical use and provides a high confidence level in the accurate operation of HDR units. Therefore, regular QA of HDR brachytherapy is essential for successful treatment.

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EVALUATION OF BRACHYTHERAPY FACILITY SHIELDING STATUS IN KOREA OBTAINED FROM RADIATION SAFETY REPORTS

  • Keum, Mi Hyun;Park, Sung Ho;Ahn, Seung Do;Cho, Woon-Kap
    • Nuclear Engineering and Technology
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    • v.45 no.5
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    • pp.695-700
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    • 2013
  • Thirty-eight radiation safety reports for brachytherapy equipment were evaluated to determine the current status of brachytherapy units in Korea and to assess how radiation oncology departments in Korea complete radiation safety reports. The following data was collected: radiation safety report publication year, brachytherapy unit manufacturer, type and activity of the source that was used, affiliation of the drafter, exposure rate constant, the treatment time used to calculate workload and the HVL values used to calculate shielding design goal values. A significant number of the reports (47.4%) included the personal information of the drafter. The treatment time estimates varied widely from 12 to 2,400 min/week. There was acceptable variation in the exposure rate constant values (ranging between 0.469 and 0.592 ($R{\cdot}m^2/Ci{\cdot}hr$), as well as in the HVLs of concrete, steel and lead for Iridium-192 sources that were used to calculate shielding design goal values. There is a need for standard guidelines for completing radiation safety reports that realistically reflect the current clinical situation of radiation oncology departments in Korea. The present study may be useful for formulating these guidelines.

Dosimetry of Brachytherapy Sources: Review of The AAPM TG-43 Formalism

  • Cho, Sang-Hyun
    • Proceedings of the Korean Society of Medical Physics Conference
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    • pp.141-143
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    • 2002
  • In 1995, the American Association of Physicists in Medicine (AAPM) Task Group 43 published a report dealing with the dosimetry of interstitial brachytherapy sources, generally known as the TG-43 report. Compared to previously adopted formalisms, a formalism proposed in this report provides a more accurate and systematic brachytherapy dose calculation method, especially for Ir-192 and other low energy gamma sources such as 1-125 and Pd-l03. In this lecture, an overview of the TG-43 formalism will be presented, along with the lecturer's experience in determining the TG-43 parameters by the Monte Carlo method and experimental methods such as TLD and radiochromic film.

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