Brachytherapy

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Brachytherapy

• Edwin L. Dove
• 51060

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Definition
Brachytherapy comes from a Greek root meaning
from within or close by. It is the practice
of treating cancer by placing a radioactive
source(s) directly into the cancer tissue, thus
giving the radiation from the inside out, rather
than having to penetrate from the outside in
through normal tissues.
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Uses of Brachytherapy

• Form of nuclear medicine used only in early
  detected carcinomas
• Cancers
• Prostate
• Ultrasound
• Plan radiation
• Deliver to affected tissue
• Low or high dose
• Breast
• Ultrasound or X-ray
• Plan radiation
• Deliver
• Usually high dose

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Prostate Tumor
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Prostate
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Metastasizing Tumor
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Ultrasound Probe
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Prostate Ultrasound Image
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Build 3D Picture
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Radiation Planning
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Radiation Beads
125Iodine or 103Palladium
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Low Dose Radiation (Permanent)
X-ray of pelvis
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High Dose Radiation (Temporary)
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Clinical Procedure
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Perineal Template
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Inserting Needles
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Low Dose Brachytherapy
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High Dose Brachytherapy
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The Relaxed Patient
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Results

• A total of 551 consecutive patients were treated.
  Of these, 320/551 (58) received implant alone
  (Group I), and 231/551 (42)--considered higher
  risk patients--were also treated with a modest
  dose (45 Gy) of external beam irradiation (Group
  II). The median follow-up for Group I was 55
  months, and for Group II, 60 months.
• At 7 years, the actuarial freedom from
  biochemical failure (prostate-specific antigen
  (PSA) lt or 1.0 ng/mL) was 80 in Group I
  patients, and, at 8 years, 65 in Group II
  patients. Morbidity was minimal if patients had
  not undergone prior transurethral prostate
  resections.

Brachytherapy for clinically localized prostate
cancer results at 7- and 8-year follow-up. Ragde
H, Blasko JC, Grimm PD, Kenny GM, Sylvester J,
Hoak DC, Cavanagh W, Landin K.
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Breast Cancer
Recurrence rates following lumpectomy and whole
breast external beam radiotherapy are
approximately 10. The majority of recurrences
are in the vicinity of the lumpectomy site. In
fact, only about 3.5 of recurrences are in
remote areas of the breast.
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Brachytherapy
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Brachytherapy
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Brachytherapy Treatments
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Current Standard Use

• Only selected breast cancer patients may be
  candidates for this type of therapy. At the
  minimum, early stage breast cancer patients must
  meet all the following criteria 1.Tumor size
  of 3 centimeters or less 2 No positive lymph
  nodes
• 3.Negative or clear margins around the tumor
  4.Within 8 weeks of lumpectomy or within 3
  weeks after finishing chemotherapy.
• While studies using breast brachytherapy appear
  to suggest that this treatment has promise, it is
  important to point out that the data are still
  preliminary and the technique should be
  considered investigational.

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Results
The National Cancer Institute sponsored a trial
enrolling 196 patients. Results were reported in
Oct. 2002. Recurrence rates at 5 years were as
good as or superior to studies giving standard
external beam radiation therapy. No harmful side
effects were noted, and cosmetic results were
good to excellent in 92 of patients.