intracavitary brachytherapy

8/8/2019 Intracavitary Brachytherapy

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Intracavitary Brachytherapy


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Why Intracavitary Brachytherapy

All advantages of Brachytherapy

Anatomical Advantage inherent to location

Biological Advantage of tissues

Extensive Clinical Experience


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Timeline of Brachytherapy

1895 December. Discovery of x-rays by Wilhem Conrad Roentgen. JuliusMaximilian University of Wurzburg, Germany.

1896 February. Discovery of natural radioactivity by Antoine HenriBecquerel, Paris, France.

1896 Report of a child treated by Dr. L. Freund, a dermatologist, withradiation successfully in Vienna for a hairy nevus.

1896 July. First documented treatment of a cancer of the stomach patientwith radiation by Victor Despeignes in Lyon, France.

1898 July. Marie and Pierre Curie report the discovery of Plutonium,

named after Maries country of origin. 1898 December. Marie and Pierre Curie report the discovery of Radium

Paris School of Physics and Chemistry, Paris, France.


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Timeline of Brachytherapy

1901 Henri Becquerel and Pierre Curie observed the biological effects ofradium on the skin. Becquerel carried a radium tube in his waistcoat pocketand Pierre Curie intentionally exposed his arm.

1903 Henri Becquerel and Marie and Pierre Curie are awarded thePhysics Nobel Prize.

1903 Alexander Graham Bell proposes the use of Interstitial RadiumTherapy.

1903 H. Streble describes afterloading interstitial technique.

1903 Margaret A. Cleaves describes the treatment of a gynecologicalpatient with intracavitary radium, in New York.


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Time of Brachytherapy

1904 W. Pusey and E. Caldwell treat uterine cancer with aradium capsule inserted in the uterus. First report ofintracavitary treatment.

1905 L. Wickman and P. Degrais designed applicator for

intracavitary therapy for treatment of carcinoma of the cervix. 1910 L. Wickman and P. Degrais published brachytherapy

textbook and described gynecological applicators.

1912 Dr. Koning uses of quantity of radium, The radium

Canon, for treatment of pelvic cancers.


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Problems with ICA Cervix

A wide range of applicators (indivualised moulded applicators;different sized standard applicators with ovoids or with a ring)

Different loading patterns based on different sources (iridium-192 wire; cesium-137 and iridium-192 using stepping source

technology) Different dose prescribing and reporting systems related to

historical traditions (mg.h, dose to point A, standard andindividualised 60 Gy volume adaptation, sectional imageassisted dose and volume prescription)

Different dose rates used (LDR, MDR, PDR, HDR)

Different schedules of dose (rate) and fractionation


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Anatomy Primer

Uterus

Cervix

Vagina

Lymphatics Are they important for ICA

Reason for high radiation tolerance


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Classical Systems


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Stockholm System

Dominici 1913, Forsell 1914,

Radiumhemment,Stockholm,Sweden

Tandem: metal tube

Colpostats: metal box wrappedin lead?

Three applications in of 20 to 30hours over a period of threeweeks.

Loading:Tandem 33.7 to 40.1 mgs RdVaginal plaque: 70 mgs Rd

Dose: 6844 to 7266 mgm/hrs

intracavitary brachytherapy

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