INTRODUCTION TO BRACHYTHERAPY, HISTORY AND INDICATIONS Christine Haie-Meder Brachytherapy Unit
HISTORY OF BRACHYTHERAPY 8/11/1895 Röentgen : X-ray discovery 22/11/1895 Mrs Röentgen s hand X-ray 1896 Becquerel : radioactivity discovery
HISTORY OF BRACHYTHERAPY 1898 Pierre and Marie Curie : radium discovery
HISTORY OF BRACHYTHERAPY
HISTORY OF BRACHYTHERAPY Plesiobrachytherapy As of 1901 : treatment of all kinds of skin lesions
HISTORY OF BRACHYTHERAPY Plesiobrachytherapy 1905 Melbourne, Australia
HISTORY OF BRACHYTHERAPY Plesiobrachytherapy Moulage technique development
HISTORY OF BRACHYTHERAPY No real concern on radioprotection
HISTORY OF BRACHYTHERAPY Plesiobrachytherapy Gynaecological applications Regaud s colpostat
HISTORY OF BRACHYTHERAPY Plesiobrachytherapy Prostate / breast / head and neck cancer
HISTORY OF BRACHYTHERAPY Interstitial brachytherapy Development of radium needles
Radium use led to some excess
HISTORY OF BRACHYTHERAPY Different brachytherapy schools Radiumhemmet Memorial Hospital Institut du Radium Stockholm New York Paris Different methods and rules Stockholm method for gyne (1914) Paris method for gyne (1919) Manchester system (1934) Paterson-Parker, Meredith Paris system for IB : Pierquin, Chassagne, Dutreix
HISTORY OF BRACHYTHERAPY 1960-70 : the end of radium Radium cured thousands of patients Radioprotection Radon contamination (Ra needle/tube cracking) In France 5/10/1976 : bylaw n 76-16714 end of radium But this was not the end of the brachytherapy story
BASES FOR MODERN BRACHYTHERAPY Discovery of artificial radioactive isotopes 1934 Irene Curie - Fréderic Joliot 1958 Iridium 192 : U. Henschke Development of afterloading concept 1958-65 U. Henschke - D. Chassagne Development of 3D dosimetry and fundamental rules of dosimetry 1965 B. Pierquin - D. Chassagne - A. Dutreix
IR 192 - PHYSICAL CHARACTERISTICS
BRACHYTHERAPY INDICATIONS Main advantages Organ sparing possibility versus surgery Ballistic selectivity CTV = PTV Small treated volumes Short treatment time Critical position of organs at risk Accessible for application or implantation technique Increasing indications because of progress in tumor accessibility : technology/imaging
BRACHYTHERAPY INDICATIONS Gynaecological tumors Prostate Head and neck Breast Anal canal Penile Oesophagus Bronchus Soft tissue sarcoma RMS pediatrics Cervix Endometrium Vagina Vulva Lip Nasal sulcus Mobile tongue Floor of mouth Soft palate Tonsil Base of tongue
ORGAN SPARING
ORGAN SPARING
BALLISTIC SELECTIVITY
AFTER LOADING TECHNIQUES Manual or remote control afterloading gyne applicators/moulds guide needles plastic tubes endoluminal catheters Remote control afterloaders Radioprotection - medical staff, nurses, visitors Quality of the implant - careful placement of source carriers - possible adjustments
GYNE APPLICATORS
STEPPING SOURCE AFTER LOADERS Radioprotection One source replacement Co 60, Ir 192 Optimization possibilities HDR / PDR
X 1,5 X 1,5 X 1,5
DIFFERENT SCHOOLS / COMMON LANGUAGE Different schools Common language needed for recording / reporting General philosophy prescribe dose according to school - system report according to international accepted reference points and volumes systems based on large experience - patient selection - special applicator types and techniques - specific loading patterns - specific dose rates be carefull with own modifications
RECOMMENDATIONS FOR RECORDING AND REPORTING 1985 ICRU 38 : Gynecological brachytherapy 1997 ICRU 58 : Interstitial and intraluminal brachytherapy 2013 ICRU 89 : Prescribing, Recording, and Reporting Brachytherapy for Cancer of the Cervix 2000 GEC-ESTRO Rec : Prostate Permanent Implants 2001 GEC-ESTRO Rec : Endovascular brachytherapy 2005 GEC-ESTRO Rec : Prostate Temporary Implants 2005/2006 GEC-ESTRO Rec : 3D GYNE (1) (2) 2008/2017 GEC-ESTRO Rec : Head and Neck 2010 GEC-ESTRO Rec : Selection criteria APBI 2012 GEC-ESTRO Rec : MRI imaging cervix cancer 2013 GEC-ESTRO Rec : HDR prostate 2015 GEC-ESTRO Rec : Breast target definition/delineation closed cavity 2016 GEC-ESTRO Rec : Breast target definition/delineation open cavity 2017 GEC-ESTRO Rec : Bladder
COMPETITION WITH SURGERY / OTHER RADIATION MODALITIES
BRACHYTHERAPY : CONCLUSION High ballistic selectivity Adaptivity Strong collaboration between - radiation oncologists - organ specialists - medical physicists - radiation technologists Specific training