Intraoperative HDR Brachytherapy: Present and Future

摘要: textabstractRadiotherapy is one of the most effective modalities in cancer treatment, and can be applied either by external beam radiotherapy or brachytherapy. Brachytherapy a treatment modality which tumors are irradiated positioning radioactive sources very close to tumor volume. The use (fractionated) HDR PDR brachytherapy has increased dramatically. In chapter 2 techniques results fractionated for head neck presented. HDR/PDR usually performed with single stepping source afterloaders, containing small Iridium-192 source, enabling optimization dose distribution dwell times over all positions implant. 3 effects geometric on interstitial volume implants have been studied terms irradia¬ted volume, uniformity, choice reference dose. The anatomy based inverse planning prostate evaluated 4. An Integrated Unit (IBU), i.e. shielded operating room an afterloader dedicated localiser, connected computer, was established at Erasmus MC – Daniel Den Hoed Cancer Center. This set-up enables integration entire brachy¬therapy procedure, implantation, implant reconstruction, delivery session. 5 reconstruction accuracy this localiser simulations measurements using phantoms representing clinical relevant geometries. When converting on-line importing fluoroscopy images directly computer image distortions present should eliminated. 6, IBU distortion correction algorithms evaluated. The availability intraoperative (IOBT). IOBT mm thick flexible template (FIT). To reduce procedure time, standard plans, that neglect curvature FIT. 7 we calculated individual plan, real geometry FIT, clips placed during surgery, 32 patients locally advanced rectal treated way. 8 technique results, local failure survival, recurrent discussed. A taskgroup quality assurance (QA) systems Netherlands Commission Radiation Dosimetry develop nation wide accepted guidelines QA investigated treatments 33 institutions Belgium, determining (chapter 9). 10 practice Belgium compared international recommendations. determination air kerma rate related uncertainty discussed 11. In 12 presented (intraoperative) some more detail future perspectives presented.