Intracavitary Brachytherapy

Why Intracavitary Brachytherapy

● All advantages of Brachytherapy
● Anatomical Advantage inherent to location
● Biological Advantage of tissues
● Extensive Clinical Experience
 Timeline of Brachytherapy
● 1895 — December. Discovery of x-rays by Wilhem Conrad Roentgen. Julius
Maximilian University of Wurzburg, Germany.
● 1896 — February. Discovery of natural radioactivity by Antoine Henri
Becquerel, Paris, France.
● 1896 — Report of a child treated by Dr. L. Freund, a dermatologist, with
radiation successfully in Vienna for a “hairy nevus.”
● 1896 — July. First documented treatment of a cancer of the stomach patient
with radiation by Victor Despeignes in Lyon, France.
● 1898 — July. Marie and Pierre Curie report the discovery of Plutonium,
named after Marie’s country of origin.
● 1898 — December. Marie and Pierre Curie report the discovery of Radium
Paris School of Physics and Chemistry, Paris, France.
 Timeline of Brachytherapy
● 1901 — Henri Becquerel and Pierre Curie observed the biological effects of
radium on the skin. Becquerel carried a radium tube in his waistcoat pocket
and Pierre Curie intentionally exposed his arm.
● 1903 — Henri Becquerel and Marie and Pierre Curie are awarded the
Physics Nobel Prize.
● 1903 — Alexander Graham Bell proposes the use of Interstitial Radium
Therapy.
● 1903 — H. Streble describes afterloading interstitial technique.
● 1903 — Margaret A. Cleaves describes the treatment of a gynecological
patient with intracavitary radium, in New York.
 Time of Brachytherapy
● 1904 — W. Pusey and E. Caldwell treat uterine cancer with a
radium capsule inserted in the uterus. First report of
intracavitary 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.
 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 and
individualised 60 Gy volume adaptation, sectional image
assisted dose and volume prescription)
● Different dose rates used (LDR, MDR, PDR, HDR)
● Different schedules of dose (rate) and fractionation
 Anatomy Primer
● Uterus
● Cervix
● Vagina
● Lymphatics – Are they important for ICA
● Reason for high radiation tolerance
Classical Systems
 Stockholm System
Dominici 1913, Forsell 1914,
Radiumhemment,Stockholm,
Sweden
Tandem: metal tube
Colpostats: metal box wrapped
in lead?
Three applications in of 20 to 30
hours over a period of three
weeks.
Loading:
Tandem 33.7 to 40.1 mgs Rd
Vaginal plaque: 70 mgs Rd
Dose: 6844 to 7266 mgm/hrs