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Principles and Clinical Applications of Pulsed Dose Rate Brachytherapy

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Technical Basis of Radiation Therapy

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Abstract

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).

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Abbreviations

APBI:

Accelerated partial breast irradiation

PDR:

Pulsed dose rate

PDR-BT:

Pulsed dose rate brachytherapy

LDR:

Low dose rate

MDR:

Medium dose rate

SCC:

Squamous cell carcinoma

DFS:

Disease-free survival

LC:

Local control

EBRT:

External beam radiation therapy

MUPIT:

Martinez Universal Perineal Interstitial Applicator

Ir:

Iridium

OAR:

Organs at risk

HNC:

Head and neck cancer

BED:

Biologically effective dose

GEC-ESTRO:

Groupe Européen de Curiethérapie-European Society for therapeutic radiation oncology

ASTRO:

American Society for radiation oncology

ABS:

American Brachytherapy Society

ASBS:

American Society of breast surgeons

5-FU:

5-Fluorouracil

DVH:

Dose volume histogram

LVSI:

Lymphovascular space invasion

F:

Fraction

STIC:

Soutien aux Thérapeutiques Innovantes et Coûteuses

EMBRACE:

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

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Authors and Affiliations

  1. Department of Human Oncology, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA

    Bethany Anderson

  2. Institut Gustave Roussy, Brachytherapy Unit, 114 rue Edouard Vaillant, 94800, Villejuif, France

    Christine Haie-Meder

  3. Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium

    Erik Van Limbergen

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  1. Bethany Anderson
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  2. Christine Haie-Meder
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  3. Erik Van Limbergen
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Correspondence to Christine Haie-Meder .

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Editors and Affiliations

  1. Institutet Stockholm Sweden, MMC 436, Dept.of Oncol-Pathol Karolinska, Delaware St. SE 420, Minneapolis, 55455, Minnesota, USA

    Seymour H. Levitt

  2. UC Davis Cancer Center, Dept. Radiation Oncology, University of California, Davis, X Street 4501, Sacramento, 95817, California, USA

    James A. Purdy

  3. School of Medicine, Dept. Radiation Oncology, Washington University, Forest Park Ave. 4511, St. Louis, 63108-2138, Michigan, USA

    Carlos A. Perez

  4. Instituut Verbeeten, Tilburg, 5042 SB, Netherlands

    Philip Poortmans

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Anderson, B., Haie-Meder, C., Van Limbergen, E. (2011). Principles and Clinical Applications of Pulsed Dose Rate Brachytherapy. In: Levitt, S., Purdy, J., Perez, C., Poortmans, P. (eds) Technical Basis of Radiation Therapy. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_262

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