Review of brachytherapy in
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1 Medical Physics in the Baltic States 2017 Review of brachytherapy in Klaipėda University Hospital Romas Vilkas Rasa Dagienė Klaipėda University Hospital 1
2 Aims of presentation: To show progress of brachytherapy department in Klaipeda University hospital To present the procedures which we perform To introduce the results And present future goals 2
3 Brachytherapy equipment in Klaipėda University Hospital High dose rate (HDR) unit and planning system: HDR Afterloading System MultiSource (Co-60); Installation HDR equipment 2010 Activity (GBq) 71,58 Source change in 2015 Integrated in-vivo dosimetry for Bladder / Rectum; Planning system HDRplus 3.0.8; 3
4 New ultrasound device 2017 Model bk3000 Transducers: Transrectal, transvaginal E14L4b; Frequency range ( MHz); Abdominal 6C2; Frequency range (6 MHz); 4
5 Cases of treatment: Ca cervix uteri Ca corporis uteri Ca prostate Breast Skin Palliative treatment Brachytherapy department
6 Numbers of patients in brahytherapy from 2010 till today Total number of patients 986 Ca cervix uteri 372 (1488 procedure): with Fletcher and with Vaginal applicator ; Ca corporis uteri cancer 260 (1040 procedure): with Vaginal applicator of different diameter; Prostate cancer 298 (449 procedure); Breast cancer 9 (37 procedure); Skin cancer 7 patient; Palliative treatment - 8: Rectum cancer -3 Pulmonum- 2 Breast - 3
7 2010 July we started 2D intracavitary treatment planning of cervix uteri and corporis uteri AP Lateral Planning cervix uteri: Prescribe dose 7 Gy to point A. (21Gy/3f.) OAR: Rectum point Bladder point 7
8 From D treatment planing 8
9 3D planning for gynaecology Prescribe dose to A point. (4x7 Gy) Rectum and Bladder 2cc. EQD2 Limits for Rectum 70-75Gy. Limits for Bladder Gy. Limits for Sigmoid 75 Gy. 9
10 2017 Interstitial techniqes for Cervical Cancer Applied for 5 patients new method Interstitial techniques aims: adequate target coverage; spare OAR; Plastic needles insertion is performed by ultrasound device control Ring applicator 10
11 Future Plans 11
12 2012 HDR brachytherapy for prostate High dose rate brachytherapy for prostate cancer; HDR Afterloading System MultiSource (Co-60); Grid and metal needles; Stepper; Planing system HDRplus Ultrasound images; 12
13 HDR brachytherapy for prostate cancer BOOST po EXRT (50Gy/25f) intermediate/high risk From 2012 till today treated 154 patients HDR boost 18Gy/2f EQD2 105 Gy α/β 1,5 13
14 HDR brachytherapy for prostate cancer Monotherapy Low/intermedia risk HDR mono 26Gy/2f Monotherapy started at patients treated EQD2 108 Gy α/β 1,5 14
15 From 2014 permanent LDR seed brachytherapy LDR brachytherapy (seed implantation) equipment and planning system: IsoCord needle loading station; Planning system PSID 5.0; Stepper; Ultrasound device; 15
16 LDR Brachytherapy for prostate Monotherapy Low risk patients From 2014 till today treated 125 patients BOOST (combined permanent seed brachytherapy with EXRT) Intermedia / high risk After boost EXRT (50Gy/25f.) From 2014 till today treated 15 patients 16
17 Prostate cancer Salvage Several attempts to salvage those local failure after external irradiation 2 Patients treated permanent LDR seed brachytherapy I 125, 108 Gy 1 patient 2014 and 1 patient patient treated HDR brachytherapy Co 60, 22Gy/2f 1 patient 2017 The result was very good and no complications were observed 17
18 2016 Interstitial Breast Brachytherapy We use breast template and flexible plastic catheter Accelerated partial breast irradiation (APBI) 4 patient. 32Gy/8f. (8 x 4 Gy, 2 x daily). BOOST po EXRT (50Gy) 5 patients Gy / 2 fractions Dose constrains for breast irradiation Skin Dmax < 100 % prescribe dose Rib Dmax <140 % prescribe dose High dose regions V150 <70 cm3 V200 < 20 cm3 18
19 Some interesting cases: Localization nose (skin cancer); 10 needles through nose; 25 Gy per 10 fractions; before treatment 19
20 Before treatment Results after two years 20
21 Some interesting cases: Localization right site of face; 14 plastic applicators and 1 plastic mask 30 Gy per 5 fractions before treatment 21
22 After 2 year 22
23 Thank you for your attention! 23
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