Principles and Clinical Applications of Pulsed Dose Rate Brachytherapy

  • Bethany Anderson
  • Christine Haie-Meder
  • Erik Van Limbergen
Part of the Medical Radiology book series (MEDRAD)


Pulsed dose rate (PDR) brachytherapy (BT) was first proposed in 1991 (Brenner and Hall Int J Radiat Oncol Biol Phys 20(1):181–190, 1991), and has been increasingly put into clinical use over the past two decades. This technique unites the benefits of the modern stepping-source afterloading unit (radiation safety and dose optimization) with the radiobiologic advantages of low dose rate (LDR) BT. Almost every LDR or high-dose rate (HDR) technique can be adapted for PDR-BT, with appropriate modifications of the applicator and the dose schedule. Conservative continuous treatment regimens with overall dose and treatment time equivalent to standard LDR-BT have been most widely accepted; however, “office hour” or “daytime” PDR-BT regimens have also been modeled and studied on a more limited basis. When transitioning from HDR or LDR to PDR-BT, it is recommended that changes in overall technique and prescription method be introduced gradually, in a step-by-step fashion. Careful attention to national regulations regarding issues such as shielding requirements and availability of authorized user(s) during treatment is mandatory. PDR-BT has been successfully applied to many tumor types, as summarized in this chapter. One major use of the technology has been for MRI-guided cervical cancer BT, which has been the subject of two large multi-institutional clinical trials (EMBRACE and STIC-PDR (Cancer Radiother 10(6–7):402–409, 2006; Cancer Radiother 12(6–7):527–531, 2008)). A multi-institutional German-Austrian trial of accelerated partial breast irradiation delivered via PDR or HDR-BT has also been conducted (Brachytherapy 1(3):149–153, 2010).


High Dose Rate Accelerate Partial Breast Irradiation Penile Cancer Vulvar Cancer Soft Tissue Necrosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Accelerated partial breast irradiation


Pulsed dose rate


Pulsed dose rate brachytherapy


Low dose rate


Medium dose rate


Squamous cell carcinoma


Disease-free survival


Local control


External beam radiation therapy


Martinez Universal Perineal Interstitial Applicator




Organs at risk


Head and neck cancer


Biologically effective dose


Groupe Européen de Curiethérapie-European Society for therapeutic radiation oncology


American Society for radiation oncology


American Brachytherapy Society


American Society of breast surgeons




Dose volume histogram


Lymphovascular space invasion




Soutien aux Thérapeutiques Innovantes et Coûteuses


International study on MRI-guided brachytherapy in locally advanced cervical cancer


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Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Bethany Anderson
    • 1
  • Christine Haie-Meder
    • 2
  • Erik Van Limbergen
    • 3
  1. 1.Department of Human OncologyUniversity of WisconsinMadisonUSA
  2. 2.Institut Gustave Roussy, Brachytherapy UnitVillejuifFrance
  3. 3.Department of Radiation OncologyUniversity Hospital LeuvenLeuvenBelgium

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