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Brachytherapy and GYN malignancy
Brachytherapy
bull Brachytherapy (brachy from the Greek for ldquoshort distancerdquo) consists of placing sealed radioactive sources close to or contact with the target tissue
bull Interstitial intracavity or transluminal approach
bull Temporary or permanent implant
bull Low or high dose rate
Introduction
bull Discovery in 1898
bull Short distance (cm)
bull High radiation dose can be delivered locally to the tumor with rapid dose fall-off in the surrounding normal tissue
Radioactive sources
Radioactive sourcesRadium-226
bull Average energy 083Mev (05mm of platinum)bull A filtration of at least 05mm platinum is sufficient
to absorb all the α particles and most of the β particles emitted by the radium and its daughter products
bull Half life ~1600 yearsbull It was loaded into cells about 1cm long and 1mm
in diameter bull Radium sources are manufactured as needles or
tubes in a variety of lengths and activities
Radioactive sourcesCesium-137
bull Substitute for radium in both interstitial and intracavitary brachytherapy
bull Energy 0662Mev nearly the same penetrating power as radium
bull Half life 30 years (clinically used 7 years without replacement) It was doubly encapsulated in stainless-steel needles and tubes
Radioactive sourcesCobalt-60
bull High specific activitybull Small sources required for some special a
pplicators
bull More expensive than 137
Cs and short half life (526 years)
bull The sources can be used to replace 226Ra in intracavitary application
Radioactive sourcesIridium-192
bull It has a complicated γ ray spectrum with an average energy of 038 MeV rarr It required less shielding for personnel protection
bull It has the disadvantage of a short half-life (738 days)
bull It is fabricated in the form of thin flexible wires which can be cut to desired lengths
Radioactive sourcesIodine-125
bull Widely used for permanent implants
bull Longer half-life 594 days (convenient for storage)
bull Low photon energy (0028MeV) rarr less shielding
bull Disadvantages dosimetry of 125I is much more complex
BrachytherapyPermanently Implanted
Source Energy
T12 Dose Rate
222Rn 12MeV
383 075Gh
198Au 412keV
270 107Gh
125I 28keV 596 007Gh
13Pd 22keV 17 019Gh
Radioactive sourcesbull ICRU38 LDR sources 04-2 Gyhr (137Cs) HDR sources ge 12 Gyhr (60Co 192Ir)bull 226Ra leakage Radon gasbull 137Cs better than 226Ra less shielding and microsphe
re form with leakage gas bull 137Cs better than 60Co less shielding and cheapbull 192Ir better than 137Cs lower energy require less shiel
ding for personnal protection and higher specific activity
bull 103Pd better than 198Au and 125I less shielding and biologic advantage
Low Dose Rate (LDR) High Dose Rate (HDR)
Patient bullLong history of use bullAbility to predict rate of late complications
bullNo long term confinement to bedbullNo indwelling bladder cathetersbullNot labeled ldquoradiation risk zonerdquo to relative visitors and staffbullAvoid several anesthesias
Clinical bullImproves chances of atching tumors in sensitive phase of cell cycle
bullMaintain position of the sources during the brief treatmentbullPatient preparationbullNo specialized nursingbullAbility to treat great patient loads
Physical
bullLonger treatment times allow for leisurely review of and potential modifications to the treatment bullPlan prior to the delivery of a significant portion of treatmentbullFavorable dose-rate effect on repair of normal tissuesbullInfrequent replacement and calibration of sources because of long isotope half-life
bullShort treatment times and minimal radiation protection problemsbullPossibility of optimizing dose distribution by altering the dwell times of the source at different
Radioactive sourcesRadioactive sources
Brachytherapy and GYN Malignancy
Reference point from which lymph node position were measured on lymphoangiograms and the rang
e of locationInt J Radiat Oncol Biol Phys 34167-172 1996
Distribution of pelvic node metastases in patients with Ib-IIa cervical cancer
Gynecol Oncol 6219-24 1996
Tumor size lt=4 cm Local advanced tumor
External beam radiotherapy for GYN Malignancy
Pelvic irradiation portal in cervical cancer4-field box technique
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Brachytherapy
bull Brachytherapy (brachy from the Greek for ldquoshort distancerdquo) consists of placing sealed radioactive sources close to or contact with the target tissue
bull Interstitial intracavity or transluminal approach
bull Temporary or permanent implant
bull Low or high dose rate
Introduction
bull Discovery in 1898
bull Short distance (cm)
bull High radiation dose can be delivered locally to the tumor with rapid dose fall-off in the surrounding normal tissue
Radioactive sources
Radioactive sourcesRadium-226
bull Average energy 083Mev (05mm of platinum)bull A filtration of at least 05mm platinum is sufficient
to absorb all the α particles and most of the β particles emitted by the radium and its daughter products
bull Half life ~1600 yearsbull It was loaded into cells about 1cm long and 1mm
in diameter bull Radium sources are manufactured as needles or
tubes in a variety of lengths and activities
Radioactive sourcesCesium-137
bull Substitute for radium in both interstitial and intracavitary brachytherapy
bull Energy 0662Mev nearly the same penetrating power as radium
bull Half life 30 years (clinically used 7 years without replacement) It was doubly encapsulated in stainless-steel needles and tubes
Radioactive sourcesCobalt-60
bull High specific activitybull Small sources required for some special a
pplicators
bull More expensive than 137
Cs and short half life (526 years)
bull The sources can be used to replace 226Ra in intracavitary application
Radioactive sourcesIridium-192
bull It has a complicated γ ray spectrum with an average energy of 038 MeV rarr It required less shielding for personnel protection
bull It has the disadvantage of a short half-life (738 days)
bull It is fabricated in the form of thin flexible wires which can be cut to desired lengths
Radioactive sourcesIodine-125
bull Widely used for permanent implants
bull Longer half-life 594 days (convenient for storage)
bull Low photon energy (0028MeV) rarr less shielding
bull Disadvantages dosimetry of 125I is much more complex
BrachytherapyPermanently Implanted
Source Energy
T12 Dose Rate
222Rn 12MeV
383 075Gh
198Au 412keV
270 107Gh
125I 28keV 596 007Gh
13Pd 22keV 17 019Gh
Radioactive sourcesbull ICRU38 LDR sources 04-2 Gyhr (137Cs) HDR sources ge 12 Gyhr (60Co 192Ir)bull 226Ra leakage Radon gasbull 137Cs better than 226Ra less shielding and microsphe
re form with leakage gas bull 137Cs better than 60Co less shielding and cheapbull 192Ir better than 137Cs lower energy require less shiel
ding for personnal protection and higher specific activity
bull 103Pd better than 198Au and 125I less shielding and biologic advantage
Low Dose Rate (LDR) High Dose Rate (HDR)
Patient bullLong history of use bullAbility to predict rate of late complications
bullNo long term confinement to bedbullNo indwelling bladder cathetersbullNot labeled ldquoradiation risk zonerdquo to relative visitors and staffbullAvoid several anesthesias
Clinical bullImproves chances of atching tumors in sensitive phase of cell cycle
bullMaintain position of the sources during the brief treatmentbullPatient preparationbullNo specialized nursingbullAbility to treat great patient loads
Physical
bullLonger treatment times allow for leisurely review of and potential modifications to the treatment bullPlan prior to the delivery of a significant portion of treatmentbullFavorable dose-rate effect on repair of normal tissuesbullInfrequent replacement and calibration of sources because of long isotope half-life
bullShort treatment times and minimal radiation protection problemsbullPossibility of optimizing dose distribution by altering the dwell times of the source at different
Radioactive sourcesRadioactive sources
Brachytherapy and GYN Malignancy
Reference point from which lymph node position were measured on lymphoangiograms and the rang
e of locationInt J Radiat Oncol Biol Phys 34167-172 1996
Distribution of pelvic node metastases in patients with Ib-IIa cervical cancer
Gynecol Oncol 6219-24 1996
Tumor size lt=4 cm Local advanced tumor
External beam radiotherapy for GYN Malignancy
Pelvic irradiation portal in cervical cancer4-field box technique
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Introduction
bull Discovery in 1898
bull Short distance (cm)
bull High radiation dose can be delivered locally to the tumor with rapid dose fall-off in the surrounding normal tissue
Radioactive sources
Radioactive sourcesRadium-226
bull Average energy 083Mev (05mm of platinum)bull A filtration of at least 05mm platinum is sufficient
to absorb all the α particles and most of the β particles emitted by the radium and its daughter products
bull Half life ~1600 yearsbull It was loaded into cells about 1cm long and 1mm
in diameter bull Radium sources are manufactured as needles or
tubes in a variety of lengths and activities
Radioactive sourcesCesium-137
bull Substitute for radium in both interstitial and intracavitary brachytherapy
bull Energy 0662Mev nearly the same penetrating power as radium
bull Half life 30 years (clinically used 7 years without replacement) It was doubly encapsulated in stainless-steel needles and tubes
Radioactive sourcesCobalt-60
bull High specific activitybull Small sources required for some special a
pplicators
bull More expensive than 137
Cs and short half life (526 years)
bull The sources can be used to replace 226Ra in intracavitary application
Radioactive sourcesIridium-192
bull It has a complicated γ ray spectrum with an average energy of 038 MeV rarr It required less shielding for personnel protection
bull It has the disadvantage of a short half-life (738 days)
bull It is fabricated in the form of thin flexible wires which can be cut to desired lengths
Radioactive sourcesIodine-125
bull Widely used for permanent implants
bull Longer half-life 594 days (convenient for storage)
bull Low photon energy (0028MeV) rarr less shielding
bull Disadvantages dosimetry of 125I is much more complex
BrachytherapyPermanently Implanted
Source Energy
T12 Dose Rate
222Rn 12MeV
383 075Gh
198Au 412keV
270 107Gh
125I 28keV 596 007Gh
13Pd 22keV 17 019Gh
Radioactive sourcesbull ICRU38 LDR sources 04-2 Gyhr (137Cs) HDR sources ge 12 Gyhr (60Co 192Ir)bull 226Ra leakage Radon gasbull 137Cs better than 226Ra less shielding and microsphe
re form with leakage gas bull 137Cs better than 60Co less shielding and cheapbull 192Ir better than 137Cs lower energy require less shiel
ding for personnal protection and higher specific activity
bull 103Pd better than 198Au and 125I less shielding and biologic advantage
Low Dose Rate (LDR) High Dose Rate (HDR)
Patient bullLong history of use bullAbility to predict rate of late complications
bullNo long term confinement to bedbullNo indwelling bladder cathetersbullNot labeled ldquoradiation risk zonerdquo to relative visitors and staffbullAvoid several anesthesias
Clinical bullImproves chances of atching tumors in sensitive phase of cell cycle
bullMaintain position of the sources during the brief treatmentbullPatient preparationbullNo specialized nursingbullAbility to treat great patient loads
Physical
bullLonger treatment times allow for leisurely review of and potential modifications to the treatment bullPlan prior to the delivery of a significant portion of treatmentbullFavorable dose-rate effect on repair of normal tissuesbullInfrequent replacement and calibration of sources because of long isotope half-life
bullShort treatment times and minimal radiation protection problemsbullPossibility of optimizing dose distribution by altering the dwell times of the source at different
Radioactive sourcesRadioactive sources
Brachytherapy and GYN Malignancy
Reference point from which lymph node position were measured on lymphoangiograms and the rang
e of locationInt J Radiat Oncol Biol Phys 34167-172 1996
Distribution of pelvic node metastases in patients with Ib-IIa cervical cancer
Gynecol Oncol 6219-24 1996
Tumor size lt=4 cm Local advanced tumor
External beam radiotherapy for GYN Malignancy
Pelvic irradiation portal in cervical cancer4-field box technique
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Radioactive sources
Radioactive sourcesRadium-226
bull Average energy 083Mev (05mm of platinum)bull A filtration of at least 05mm platinum is sufficient
to absorb all the α particles and most of the β particles emitted by the radium and its daughter products
bull Half life ~1600 yearsbull It was loaded into cells about 1cm long and 1mm
in diameter bull Radium sources are manufactured as needles or
tubes in a variety of lengths and activities
Radioactive sourcesCesium-137
bull Substitute for radium in both interstitial and intracavitary brachytherapy
bull Energy 0662Mev nearly the same penetrating power as radium
bull Half life 30 years (clinically used 7 years without replacement) It was doubly encapsulated in stainless-steel needles and tubes
Radioactive sourcesCobalt-60
bull High specific activitybull Small sources required for some special a
pplicators
bull More expensive than 137
Cs and short half life (526 years)
bull The sources can be used to replace 226Ra in intracavitary application
Radioactive sourcesIridium-192
bull It has a complicated γ ray spectrum with an average energy of 038 MeV rarr It required less shielding for personnel protection
bull It has the disadvantage of a short half-life (738 days)
bull It is fabricated in the form of thin flexible wires which can be cut to desired lengths
Radioactive sourcesIodine-125
bull Widely used for permanent implants
bull Longer half-life 594 days (convenient for storage)
bull Low photon energy (0028MeV) rarr less shielding
bull Disadvantages dosimetry of 125I is much more complex
BrachytherapyPermanently Implanted
Source Energy
T12 Dose Rate
222Rn 12MeV
383 075Gh
198Au 412keV
270 107Gh
125I 28keV 596 007Gh
13Pd 22keV 17 019Gh
Radioactive sourcesbull ICRU38 LDR sources 04-2 Gyhr (137Cs) HDR sources ge 12 Gyhr (60Co 192Ir)bull 226Ra leakage Radon gasbull 137Cs better than 226Ra less shielding and microsphe
re form with leakage gas bull 137Cs better than 60Co less shielding and cheapbull 192Ir better than 137Cs lower energy require less shiel
ding for personnal protection and higher specific activity
bull 103Pd better than 198Au and 125I less shielding and biologic advantage
Low Dose Rate (LDR) High Dose Rate (HDR)
Patient bullLong history of use bullAbility to predict rate of late complications
bullNo long term confinement to bedbullNo indwelling bladder cathetersbullNot labeled ldquoradiation risk zonerdquo to relative visitors and staffbullAvoid several anesthesias
Clinical bullImproves chances of atching tumors in sensitive phase of cell cycle
bullMaintain position of the sources during the brief treatmentbullPatient preparationbullNo specialized nursingbullAbility to treat great patient loads
Physical
bullLonger treatment times allow for leisurely review of and potential modifications to the treatment bullPlan prior to the delivery of a significant portion of treatmentbullFavorable dose-rate effect on repair of normal tissuesbullInfrequent replacement and calibration of sources because of long isotope half-life
bullShort treatment times and minimal radiation protection problemsbullPossibility of optimizing dose distribution by altering the dwell times of the source at different
Radioactive sourcesRadioactive sources
Brachytherapy and GYN Malignancy
Reference point from which lymph node position were measured on lymphoangiograms and the rang
e of locationInt J Radiat Oncol Biol Phys 34167-172 1996
Distribution of pelvic node metastases in patients with Ib-IIa cervical cancer
Gynecol Oncol 6219-24 1996
Tumor size lt=4 cm Local advanced tumor
External beam radiotherapy for GYN Malignancy
Pelvic irradiation portal in cervical cancer4-field box technique
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Radioactive sourcesRadium-226
bull Average energy 083Mev (05mm of platinum)bull A filtration of at least 05mm platinum is sufficient
to absorb all the α particles and most of the β particles emitted by the radium and its daughter products
bull Half life ~1600 yearsbull It was loaded into cells about 1cm long and 1mm
in diameter bull Radium sources are manufactured as needles or
tubes in a variety of lengths and activities
Radioactive sourcesCesium-137
bull Substitute for radium in both interstitial and intracavitary brachytherapy
bull Energy 0662Mev nearly the same penetrating power as radium
bull Half life 30 years (clinically used 7 years without replacement) It was doubly encapsulated in stainless-steel needles and tubes
Radioactive sourcesCobalt-60
bull High specific activitybull Small sources required for some special a
pplicators
bull More expensive than 137
Cs and short half life (526 years)
bull The sources can be used to replace 226Ra in intracavitary application
Radioactive sourcesIridium-192
bull It has a complicated γ ray spectrum with an average energy of 038 MeV rarr It required less shielding for personnel protection
bull It has the disadvantage of a short half-life (738 days)
bull It is fabricated in the form of thin flexible wires which can be cut to desired lengths
Radioactive sourcesIodine-125
bull Widely used for permanent implants
bull Longer half-life 594 days (convenient for storage)
bull Low photon energy (0028MeV) rarr less shielding
bull Disadvantages dosimetry of 125I is much more complex
BrachytherapyPermanently Implanted
Source Energy
T12 Dose Rate
222Rn 12MeV
383 075Gh
198Au 412keV
270 107Gh
125I 28keV 596 007Gh
13Pd 22keV 17 019Gh
Radioactive sourcesbull ICRU38 LDR sources 04-2 Gyhr (137Cs) HDR sources ge 12 Gyhr (60Co 192Ir)bull 226Ra leakage Radon gasbull 137Cs better than 226Ra less shielding and microsphe
re form with leakage gas bull 137Cs better than 60Co less shielding and cheapbull 192Ir better than 137Cs lower energy require less shiel
ding for personnal protection and higher specific activity
bull 103Pd better than 198Au and 125I less shielding and biologic advantage
Low Dose Rate (LDR) High Dose Rate (HDR)
Patient bullLong history of use bullAbility to predict rate of late complications
bullNo long term confinement to bedbullNo indwelling bladder cathetersbullNot labeled ldquoradiation risk zonerdquo to relative visitors and staffbullAvoid several anesthesias
Clinical bullImproves chances of atching tumors in sensitive phase of cell cycle
bullMaintain position of the sources during the brief treatmentbullPatient preparationbullNo specialized nursingbullAbility to treat great patient loads
Physical
bullLonger treatment times allow for leisurely review of and potential modifications to the treatment bullPlan prior to the delivery of a significant portion of treatmentbullFavorable dose-rate effect on repair of normal tissuesbullInfrequent replacement and calibration of sources because of long isotope half-life
bullShort treatment times and minimal radiation protection problemsbullPossibility of optimizing dose distribution by altering the dwell times of the source at different
Radioactive sourcesRadioactive sources
Brachytherapy and GYN Malignancy
Reference point from which lymph node position were measured on lymphoangiograms and the rang
e of locationInt J Radiat Oncol Biol Phys 34167-172 1996
Distribution of pelvic node metastases in patients with Ib-IIa cervical cancer
Gynecol Oncol 6219-24 1996
Tumor size lt=4 cm Local advanced tumor
External beam radiotherapy for GYN Malignancy
Pelvic irradiation portal in cervical cancer4-field box technique
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Radioactive sourcesCesium-137
bull Substitute for radium in both interstitial and intracavitary brachytherapy
bull Energy 0662Mev nearly the same penetrating power as radium
bull Half life 30 years (clinically used 7 years without replacement) It was doubly encapsulated in stainless-steel needles and tubes
Radioactive sourcesCobalt-60
bull High specific activitybull Small sources required for some special a
pplicators
bull More expensive than 137
Cs and short half life (526 years)
bull The sources can be used to replace 226Ra in intracavitary application
Radioactive sourcesIridium-192
bull It has a complicated γ ray spectrum with an average energy of 038 MeV rarr It required less shielding for personnel protection
bull It has the disadvantage of a short half-life (738 days)
bull It is fabricated in the form of thin flexible wires which can be cut to desired lengths
Radioactive sourcesIodine-125
bull Widely used for permanent implants
bull Longer half-life 594 days (convenient for storage)
bull Low photon energy (0028MeV) rarr less shielding
bull Disadvantages dosimetry of 125I is much more complex
BrachytherapyPermanently Implanted
Source Energy
T12 Dose Rate
222Rn 12MeV
383 075Gh
198Au 412keV
270 107Gh
125I 28keV 596 007Gh
13Pd 22keV 17 019Gh
Radioactive sourcesbull ICRU38 LDR sources 04-2 Gyhr (137Cs) HDR sources ge 12 Gyhr (60Co 192Ir)bull 226Ra leakage Radon gasbull 137Cs better than 226Ra less shielding and microsphe
re form with leakage gas bull 137Cs better than 60Co less shielding and cheapbull 192Ir better than 137Cs lower energy require less shiel
ding for personnal protection and higher specific activity
bull 103Pd better than 198Au and 125I less shielding and biologic advantage
Low Dose Rate (LDR) High Dose Rate (HDR)
Patient bullLong history of use bullAbility to predict rate of late complications
bullNo long term confinement to bedbullNo indwelling bladder cathetersbullNot labeled ldquoradiation risk zonerdquo to relative visitors and staffbullAvoid several anesthesias
Clinical bullImproves chances of atching tumors in sensitive phase of cell cycle
bullMaintain position of the sources during the brief treatmentbullPatient preparationbullNo specialized nursingbullAbility to treat great patient loads
Physical
bullLonger treatment times allow for leisurely review of and potential modifications to the treatment bullPlan prior to the delivery of a significant portion of treatmentbullFavorable dose-rate effect on repair of normal tissuesbullInfrequent replacement and calibration of sources because of long isotope half-life
bullShort treatment times and minimal radiation protection problemsbullPossibility of optimizing dose distribution by altering the dwell times of the source at different
Radioactive sourcesRadioactive sources
Brachytherapy and GYN Malignancy
Reference point from which lymph node position were measured on lymphoangiograms and the rang
e of locationInt J Radiat Oncol Biol Phys 34167-172 1996
Distribution of pelvic node metastases in patients with Ib-IIa cervical cancer
Gynecol Oncol 6219-24 1996
Tumor size lt=4 cm Local advanced tumor
External beam radiotherapy for GYN Malignancy
Pelvic irradiation portal in cervical cancer4-field box technique
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Radioactive sourcesCobalt-60
bull High specific activitybull Small sources required for some special a
pplicators
bull More expensive than 137
Cs and short half life (526 years)
bull The sources can be used to replace 226Ra in intracavitary application
Radioactive sourcesIridium-192
bull It has a complicated γ ray spectrum with an average energy of 038 MeV rarr It required less shielding for personnel protection
bull It has the disadvantage of a short half-life (738 days)
bull It is fabricated in the form of thin flexible wires which can be cut to desired lengths
Radioactive sourcesIodine-125
bull Widely used for permanent implants
bull Longer half-life 594 days (convenient for storage)
bull Low photon energy (0028MeV) rarr less shielding
bull Disadvantages dosimetry of 125I is much more complex
BrachytherapyPermanently Implanted
Source Energy
T12 Dose Rate
222Rn 12MeV
383 075Gh
198Au 412keV
270 107Gh
125I 28keV 596 007Gh
13Pd 22keV 17 019Gh
Radioactive sourcesbull ICRU38 LDR sources 04-2 Gyhr (137Cs) HDR sources ge 12 Gyhr (60Co 192Ir)bull 226Ra leakage Radon gasbull 137Cs better than 226Ra less shielding and microsphe
re form with leakage gas bull 137Cs better than 60Co less shielding and cheapbull 192Ir better than 137Cs lower energy require less shiel
ding for personnal protection and higher specific activity
bull 103Pd better than 198Au and 125I less shielding and biologic advantage
Low Dose Rate (LDR) High Dose Rate (HDR)
Patient bullLong history of use bullAbility to predict rate of late complications
bullNo long term confinement to bedbullNo indwelling bladder cathetersbullNot labeled ldquoradiation risk zonerdquo to relative visitors and staffbullAvoid several anesthesias
Clinical bullImproves chances of atching tumors in sensitive phase of cell cycle
bullMaintain position of the sources during the brief treatmentbullPatient preparationbullNo specialized nursingbullAbility to treat great patient loads
Physical
bullLonger treatment times allow for leisurely review of and potential modifications to the treatment bullPlan prior to the delivery of a significant portion of treatmentbullFavorable dose-rate effect on repair of normal tissuesbullInfrequent replacement and calibration of sources because of long isotope half-life
bullShort treatment times and minimal radiation protection problemsbullPossibility of optimizing dose distribution by altering the dwell times of the source at different
Radioactive sourcesRadioactive sources
Brachytherapy and GYN Malignancy
Reference point from which lymph node position were measured on lymphoangiograms and the rang
e of locationInt J Radiat Oncol Biol Phys 34167-172 1996
Distribution of pelvic node metastases in patients with Ib-IIa cervical cancer
Gynecol Oncol 6219-24 1996
Tumor size lt=4 cm Local advanced tumor
External beam radiotherapy for GYN Malignancy
Pelvic irradiation portal in cervical cancer4-field box technique
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Radioactive sourcesIridium-192
bull It has a complicated γ ray spectrum with an average energy of 038 MeV rarr It required less shielding for personnel protection
bull It has the disadvantage of a short half-life (738 days)
bull It is fabricated in the form of thin flexible wires which can be cut to desired lengths
Radioactive sourcesIodine-125
bull Widely used for permanent implants
bull Longer half-life 594 days (convenient for storage)
bull Low photon energy (0028MeV) rarr less shielding
bull Disadvantages dosimetry of 125I is much more complex
BrachytherapyPermanently Implanted
Source Energy
T12 Dose Rate
222Rn 12MeV
383 075Gh
198Au 412keV
270 107Gh
125I 28keV 596 007Gh
13Pd 22keV 17 019Gh
Radioactive sourcesbull ICRU38 LDR sources 04-2 Gyhr (137Cs) HDR sources ge 12 Gyhr (60Co 192Ir)bull 226Ra leakage Radon gasbull 137Cs better than 226Ra less shielding and microsphe
re form with leakage gas bull 137Cs better than 60Co less shielding and cheapbull 192Ir better than 137Cs lower energy require less shiel
ding for personnal protection and higher specific activity
bull 103Pd better than 198Au and 125I less shielding and biologic advantage
Low Dose Rate (LDR) High Dose Rate (HDR)
Patient bullLong history of use bullAbility to predict rate of late complications
bullNo long term confinement to bedbullNo indwelling bladder cathetersbullNot labeled ldquoradiation risk zonerdquo to relative visitors and staffbullAvoid several anesthesias
Clinical bullImproves chances of atching tumors in sensitive phase of cell cycle
bullMaintain position of the sources during the brief treatmentbullPatient preparationbullNo specialized nursingbullAbility to treat great patient loads
Physical
bullLonger treatment times allow for leisurely review of and potential modifications to the treatment bullPlan prior to the delivery of a significant portion of treatmentbullFavorable dose-rate effect on repair of normal tissuesbullInfrequent replacement and calibration of sources because of long isotope half-life
bullShort treatment times and minimal radiation protection problemsbullPossibility of optimizing dose distribution by altering the dwell times of the source at different
Radioactive sourcesRadioactive sources
Brachytherapy and GYN Malignancy
Reference point from which lymph node position were measured on lymphoangiograms and the rang
e of locationInt J Radiat Oncol Biol Phys 34167-172 1996
Distribution of pelvic node metastases in patients with Ib-IIa cervical cancer
Gynecol Oncol 6219-24 1996
Tumor size lt=4 cm Local advanced tumor
External beam radiotherapy for GYN Malignancy
Pelvic irradiation portal in cervical cancer4-field box technique
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Radioactive sourcesIodine-125
bull Widely used for permanent implants
bull Longer half-life 594 days (convenient for storage)
bull Low photon energy (0028MeV) rarr less shielding
bull Disadvantages dosimetry of 125I is much more complex
BrachytherapyPermanently Implanted
Source Energy
T12 Dose Rate
222Rn 12MeV
383 075Gh
198Au 412keV
270 107Gh
125I 28keV 596 007Gh
13Pd 22keV 17 019Gh
Radioactive sourcesbull ICRU38 LDR sources 04-2 Gyhr (137Cs) HDR sources ge 12 Gyhr (60Co 192Ir)bull 226Ra leakage Radon gasbull 137Cs better than 226Ra less shielding and microsphe
re form with leakage gas bull 137Cs better than 60Co less shielding and cheapbull 192Ir better than 137Cs lower energy require less shiel
ding for personnal protection and higher specific activity
bull 103Pd better than 198Au and 125I less shielding and biologic advantage
Low Dose Rate (LDR) High Dose Rate (HDR)
Patient bullLong history of use bullAbility to predict rate of late complications
bullNo long term confinement to bedbullNo indwelling bladder cathetersbullNot labeled ldquoradiation risk zonerdquo to relative visitors and staffbullAvoid several anesthesias
Clinical bullImproves chances of atching tumors in sensitive phase of cell cycle
bullMaintain position of the sources during the brief treatmentbullPatient preparationbullNo specialized nursingbullAbility to treat great patient loads
Physical
bullLonger treatment times allow for leisurely review of and potential modifications to the treatment bullPlan prior to the delivery of a significant portion of treatmentbullFavorable dose-rate effect on repair of normal tissuesbullInfrequent replacement and calibration of sources because of long isotope half-life
bullShort treatment times and minimal radiation protection problemsbullPossibility of optimizing dose distribution by altering the dwell times of the source at different
Radioactive sourcesRadioactive sources
Brachytherapy and GYN Malignancy
Reference point from which lymph node position were measured on lymphoangiograms and the rang
e of locationInt J Radiat Oncol Biol Phys 34167-172 1996
Distribution of pelvic node metastases in patients with Ib-IIa cervical cancer
Gynecol Oncol 6219-24 1996
Tumor size lt=4 cm Local advanced tumor
External beam radiotherapy for GYN Malignancy
Pelvic irradiation portal in cervical cancer4-field box technique
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
BrachytherapyPermanently Implanted
Source Energy
T12 Dose Rate
222Rn 12MeV
383 075Gh
198Au 412keV
270 107Gh
125I 28keV 596 007Gh
13Pd 22keV 17 019Gh
Radioactive sourcesbull ICRU38 LDR sources 04-2 Gyhr (137Cs) HDR sources ge 12 Gyhr (60Co 192Ir)bull 226Ra leakage Radon gasbull 137Cs better than 226Ra less shielding and microsphe
re form with leakage gas bull 137Cs better than 60Co less shielding and cheapbull 192Ir better than 137Cs lower energy require less shiel
ding for personnal protection and higher specific activity
bull 103Pd better than 198Au and 125I less shielding and biologic advantage
Low Dose Rate (LDR) High Dose Rate (HDR)
Patient bullLong history of use bullAbility to predict rate of late complications
bullNo long term confinement to bedbullNo indwelling bladder cathetersbullNot labeled ldquoradiation risk zonerdquo to relative visitors and staffbullAvoid several anesthesias
Clinical bullImproves chances of atching tumors in sensitive phase of cell cycle
bullMaintain position of the sources during the brief treatmentbullPatient preparationbullNo specialized nursingbullAbility to treat great patient loads
Physical
bullLonger treatment times allow for leisurely review of and potential modifications to the treatment bullPlan prior to the delivery of a significant portion of treatmentbullFavorable dose-rate effect on repair of normal tissuesbullInfrequent replacement and calibration of sources because of long isotope half-life
bullShort treatment times and minimal radiation protection problemsbullPossibility of optimizing dose distribution by altering the dwell times of the source at different
Radioactive sourcesRadioactive sources
Brachytherapy and GYN Malignancy
Reference point from which lymph node position were measured on lymphoangiograms and the rang
e of locationInt J Radiat Oncol Biol Phys 34167-172 1996
Distribution of pelvic node metastases in patients with Ib-IIa cervical cancer
Gynecol Oncol 6219-24 1996
Tumor size lt=4 cm Local advanced tumor
External beam radiotherapy for GYN Malignancy
Pelvic irradiation portal in cervical cancer4-field box technique
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Radioactive sourcesbull ICRU38 LDR sources 04-2 Gyhr (137Cs) HDR sources ge 12 Gyhr (60Co 192Ir)bull 226Ra leakage Radon gasbull 137Cs better than 226Ra less shielding and microsphe
re form with leakage gas bull 137Cs better than 60Co less shielding and cheapbull 192Ir better than 137Cs lower energy require less shiel
ding for personnal protection and higher specific activity
bull 103Pd better than 198Au and 125I less shielding and biologic advantage
Low Dose Rate (LDR) High Dose Rate (HDR)
Patient bullLong history of use bullAbility to predict rate of late complications
bullNo long term confinement to bedbullNo indwelling bladder cathetersbullNot labeled ldquoradiation risk zonerdquo to relative visitors and staffbullAvoid several anesthesias
Clinical bullImproves chances of atching tumors in sensitive phase of cell cycle
bullMaintain position of the sources during the brief treatmentbullPatient preparationbullNo specialized nursingbullAbility to treat great patient loads
Physical
bullLonger treatment times allow for leisurely review of and potential modifications to the treatment bullPlan prior to the delivery of a significant portion of treatmentbullFavorable dose-rate effect on repair of normal tissuesbullInfrequent replacement and calibration of sources because of long isotope half-life
bullShort treatment times and minimal radiation protection problemsbullPossibility of optimizing dose distribution by altering the dwell times of the source at different
Radioactive sourcesRadioactive sources
Brachytherapy and GYN Malignancy
Reference point from which lymph node position were measured on lymphoangiograms and the rang
e of locationInt J Radiat Oncol Biol Phys 34167-172 1996
Distribution of pelvic node metastases in patients with Ib-IIa cervical cancer
Gynecol Oncol 6219-24 1996
Tumor size lt=4 cm Local advanced tumor
External beam radiotherapy for GYN Malignancy
Pelvic irradiation portal in cervical cancer4-field box technique
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Low Dose Rate (LDR) High Dose Rate (HDR)
Patient bullLong history of use bullAbility to predict rate of late complications
bullNo long term confinement to bedbullNo indwelling bladder cathetersbullNot labeled ldquoradiation risk zonerdquo to relative visitors and staffbullAvoid several anesthesias
Clinical bullImproves chances of atching tumors in sensitive phase of cell cycle
bullMaintain position of the sources during the brief treatmentbullPatient preparationbullNo specialized nursingbullAbility to treat great patient loads
Physical
bullLonger treatment times allow for leisurely review of and potential modifications to the treatment bullPlan prior to the delivery of a significant portion of treatmentbullFavorable dose-rate effect on repair of normal tissuesbullInfrequent replacement and calibration of sources because of long isotope half-life
bullShort treatment times and minimal radiation protection problemsbullPossibility of optimizing dose distribution by altering the dwell times of the source at different
Radioactive sourcesRadioactive sources
Brachytherapy and GYN Malignancy
Reference point from which lymph node position were measured on lymphoangiograms and the rang
e of locationInt J Radiat Oncol Biol Phys 34167-172 1996
Distribution of pelvic node metastases in patients with Ib-IIa cervical cancer
Gynecol Oncol 6219-24 1996
Tumor size lt=4 cm Local advanced tumor
External beam radiotherapy for GYN Malignancy
Pelvic irradiation portal in cervical cancer4-field box technique
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Brachytherapy and GYN Malignancy
Reference point from which lymph node position were measured on lymphoangiograms and the rang
e of locationInt J Radiat Oncol Biol Phys 34167-172 1996
Distribution of pelvic node metastases in patients with Ib-IIa cervical cancer
Gynecol Oncol 6219-24 1996
Tumor size lt=4 cm Local advanced tumor
External beam radiotherapy for GYN Malignancy
Pelvic irradiation portal in cervical cancer4-field box technique
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Reference point from which lymph node position were measured on lymphoangiograms and the rang
e of locationInt J Radiat Oncol Biol Phys 34167-172 1996
Distribution of pelvic node metastases in patients with Ib-IIa cervical cancer
Gynecol Oncol 6219-24 1996
Tumor size lt=4 cm Local advanced tumor
External beam radiotherapy for GYN Malignancy
Pelvic irradiation portal in cervical cancer4-field box technique
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Distribution of pelvic node metastases in patients with Ib-IIa cervical cancer
Gynecol Oncol 6219-24 1996
Tumor size lt=4 cm Local advanced tumor
External beam radiotherapy for GYN Malignancy
Pelvic irradiation portal in cervical cancer4-field box technique
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
External beam radiotherapy for GYN Malignancy
Pelvic irradiation portal in cervical cancer4-field box technique
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Pelvic irradiation portal in cervical cancer4-field box technique
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Pelvic irradiation portal in cervical cancer4-field box technique
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Combination of external beam pelvic irradiation an
d intracavitary brachytherapy (ICRT)
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Brachytherapy in definitive radiotherapy of Brachytherapy in definitive radiotherapy of cervical cancercervical cancer
(Intracavity radiotherapy ICRT)(Intracavity radiotherapy ICRT)
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Intracavitary Radiotherapy (ICRT)
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Applicator of ICRT
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Intracavitary insertion (ICRT)
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Postoperative brachytherapy(Intravaginal radiotherapy)
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Intravaginal radiotherapy (IVRT)
Female urethral cancer
Endometrial cancer
Female urethral cancer
Endometrial cancer
Endometrial cancer