Clinical assessment of 252Californium neutron intracavitary brachytherapy using a two-channel Y applicator combined with external beam radiotherapy for endometrial cancer

OBJECTIVE: The aim of this study was to determine the efficacy of 252Californium neutron intracavitary brachytherapy using a two-channel Y applicator combined with external beam radiotherapy for the treatment of endometrial cancer. METHODS: Thirty-one patients with stage I-III endometrial cancer were recruited for this study. The stage I patients received only 252Californium neutron intracavitary brachytherapy with a two-channel applicator. The stage II and III patients received both 252Californium neutron intracavitary brachytherapy using a two-channel applicator and parallel-opposed whole pelvic radiotherapy. RESULTS: The five-year local control rate was 80.6% (25/31), the overall survival rate was 51.6% (16/31), and the disease-free survival rate was 54.8% (17/31). The incidence of serious late complications was 12.9% (4/31). CONCLUSIONS: 252Californium neutron intracavitary brachytherapy using a two-channel applicator combined with external beam radiotherapy was effective for treating endometrial cancer and the incidence of serious late complications related to this combination was within an acceptable range.

Episcleral plaque brachytherapy using ‘BARC I-125 Ocu-Prosta seeds’ in the treatment of intraocular tumors: A single-institution experience in India.

Context: To analyze the results of episcleral plaque brachytherapy using indigenous Bhabha Atomic Research Centre (BARC) Iodine-125 Ocu-Prosta seeds for the management of intraocular tumors from a single institute. AIM: To report our initial experience and learning curve on the use of ‘BARC I-125 Ocu-Prosta seeds’ for the management of intraocular tumors such as choroidal melanomas, retinoblastomas and vasoproliferative tumors (VPT). Materials and Methods: We retrospectively reviewed 13 eyes of 13 patients who underwent ophthalmic brachytherapy between May 2008 to March 2012. Nine cases had choroidal melanomas; three had retinoblastomas while one case had VPT. Results: For choroidal melanomas the average apical diameter before brachytherapy was 7.6 mm and average largest basal diameter was 12.1 mm, respectively, which reduced to 4.2 mm and 7.7 mm after the procedure at an average follow-up of 24 months (range 10-43 months). Retinoblastoma and VPT also showed good regression after brachytherapy. Conclusion: Plaque radiotherapy using 125I seeds can be performed under peribulbar anesthesia and provides a viable option for the management of intraocular cancer with minimal invasiveness and surgical complications. Patients in our studies experienced excellent local tumor control. With the availability of indigenous ‘BARC I-125 Ocu-Prosta seeds’ locally, cost effective ophthalmic brachytherapy can be performed in India.

Radioactive seed migration after prostate brachytherapy with Iodine-125 using loose seeds versus stranded seeds

Objectives: To assess the incidence and clinical parameters that could influence migration of seeds in localized prostate cancer patients treated by stranded versus loose sources by Iodine-125 brachytherapy. Material and Methods: 100 patients were treated from January/1998 until December/2006. Age, PSA, clinical stage, Gleason, prostate volume, number of seeds, activity of radioactive seeds, and dosimetric parameters, such as V100, V150 and D90 were evaluated. Results: Mean follow-up was 79 months (18 - 120. CI 95 percent: 72 - 85). Overall, 6 of 100 patients experienced seed migration. Seed migration was found in 4/50 (8 percent) patients using loose seeds and in 2/50 (4 percent) treated by stranded seeds. Mean value dosimetric parameters for stranded seeds were greater than those for loose seeds (V100( percent): 88.7/82, D90(Gy): 149.2/140.3, D90( percent): 104.2/93.8, V150 ( percent): 53.8/47, respectively). No significant difference in migration of seeds was detected between loose and stranded seeds considering age (p = 0.33), PSA (p = 0.391), prostate volume (p = 0.397), activity of radioactive seeds (p = 0.109), number of seeds (p = 0.338), V100 (p = 0.332), although significant differences were measured in the values of D90( percent and Gy) (p = 0.022 and 0.011) and V150 (p = 0.023). Conclusions: Seed migration after brachytherapy might occur and it does affect post-implant dosimetry.

Avaliação dosimétrica de uma combinação de aplicadores para braquiterapia de tumores do colo uterino com acometimento da porção distal da vagina / Dosimetric evaluation of a combination of brachytherapy applicators for uterine cervix cancer with involvement of the distal vagina

OBJETIVO: Avaliar uma alternativa de braquiterapia para tumores do colo uterino acometendo a porção distal da vagina, sem aumentar os riscos de toxicidade. MATERIAIS E MÉTODOS: Estudo teórico comparando três diferentes aplicadores de braquiterapia intracavitária de alta taxa de dose: sonda intrauterina e cilindro vaginal (SC); sonda e anel associado ao cilindro vaginal (SA+C) e um aplicador virtual com sonda, anel e cilindro vaginal em um único conjunto (SAC). Foram prescritas doses de 7 Gy no ponto A e 5 Gy na superfície ou a 5 mm de profundidade na mucosa vaginal, mantendo as doses nos pontos de reto, bexiga e sigmoide abaixo dos limites de tolerância. Foram comparados os volumes englobados pelas isodoses de 50 por cento (V50), 100 por cento (V100), 150 por cento (V150) e 200 por cento (V200), respectivamente. RESULTADOS: Tanto SA+C quanto SAC apresentaram melhor distribuição de dose quando comparados ao aplicador SC. A distribuição de dose obtida com SA+C foi semelhante à do aplicador SAC, sendo V150 e V200 cerca de 50 por cento maiores para SA+C, todavia, dentro do cilindro. CONCLUSÃO: A utilização de SA+C em uma única aplicação em dois tempos pode ser uma alternativa de tratamento para pacientes que apresentam tumores de colo uterino com acometimento distal da vagina.

OBJECTIVE: To evaluate an alternative brachytherapy technique for uterine cervix cancer involving the distal vagina, without increasing the risk of toxicity. MATERIALS AND METHODS: Theoretical study comparing three different high-dose rate intracavitary brachytherapy applicators: intrauterine tandem and vaginal cylinder (TC); tandem/ring applicator combined with vaginal cylinder (TR+C); and a virtual applicator combining both the tandem/ring and vaginal cylinder in a single device (TRC). Prescribed doses were 7 Gy at point A, and 5 Gy on the surface or at a 5 mm depth of the vaginal mucosa. Doses delivered to the rectum, bladder and sigmoid colon were kept below the tolerance limits. Volumes covered by the isodoses, respectively, 50 percent (V50), 100 percent (V100), 150 percent (V150) and 200 percent (V200) were compared. RESULTS: Both the combined TR+C and TRC presented a better dose distribution as compared with the TC applicator. The TR+C dose distribution was similar to the TRC dose, with V150 and V200 being about 50 percent higher for TR+C (within the cylinder). CONCLUSION: Combined TR+C in a two-time single application may represent an alternative therapy technique for patients affected by uterine cervix cancer involving the distal vagina.

Desenvolvimento e implantação da calibração de câmaras de ionização tipo poço com fonte de 192Ir de alta taxa de dose no Brasil / Development and implementation of the calibration of ionization chambers well with 192Ir source for high dose rate in Brasil

A utilização da braquiterapia com equipamentos de pós-carga remota com fonte de 192Ir de alta taxa de dose tem aumentado em todo o mundo e no Brasil que conta hoje com 60 equipamentos instalados em Serviços de Radioterapia. A necessidade de se garantir a rastreabilidade da grandeza dosimétrica associada às fontes radioativas à Rede Internacional de Metrologia das Radiações Ionizantes tornou-se evidente e urgente, pois doses altas são aplicadas em pouco tempo ao tumor e qualquer erro na determinação dessa dose pode acarretar muito dano aos pacientes. Na ausência de um padrão dosimétrico estabelecido para o espectro de energia do 192Ir, muitos trabalhos mostraram alternativas para a calibração de fontes de 192Ir de alta taxa de dose com câmaras de ionização tipo dedal e tipo poço. A câmara poço, por ser de uso mais simples e apresentar metodologia reprodutível no ambiente de um Serviço de Radioterapia, passou a ser recomendada por instituições internacionais. Os Serviços de Radioterapia do Brasil que possuem equipamentos de pós-carga remota com fonte de 192Ir de alta taxa de dose utilizam, atualmente, a câmara tipo poço para a dosimetria de suas fontes. Como a calibração desse instrumento ainda é restrita a alguns países do hemisfério norte e a fim de suprir a necessidade do Brasil, este trabalho propõe uma metodologia para a calibração das câmaras poço dos usuários com fonte de 192Ir de alta taxa de dose, rastreada à Rede Internacional de Metrologia das Radiações Ionizantes. No método proposto é utilizada uma câmara dedal, calibrada no LNMRI/IRD/CNEN (rastreado à Rede Internacional de Metrologia das Radiações Ionizantes) em feixe de raios X e 60Co com uma interpolação adequada para a energia do 192Ir. Utiliza-se um sistema de posicionamento dessa câmara e da fonte de 192Ir de um equipamento de pós-carga remota para determinar a grandeza taxa de kerma no ar de referência dessa fonte que é, então, utilizada para calibrar as câmaras tipo poço dos usuários...

The use of brachytherapy with after-loading equipment with remote source of high dose rate 192Ir has increased worldwide and in Brazil, which presents 60 facilities with this equipment nowadays. The need to ensure the traceability of the source dosimetric quantity to the International Ionizing Radiation Metrology Network has become evident and urgent, since high doses values are delivered in a short time to the tumor and any error in the determination of the dose can provoke much damage to patients. In the absence of an established dosimetric standard for the energy spectrum of 192Ir, many studies showed alternative calibration of sources of high dose rate 192Ir, with the ionization thimble or well chamber type. The well type chamber is now recommended by international organisms, because of its simplicity to use and to its reproductibility. Nowadays, it is adopted by all radiotherapy services in Brazil using after-loading equipment with high dose rate 192Ir source. As the calibration of this instrument is still limited to some countries in the northerm hemisphere, in order to enhance the growth of the use of this instrument in Brazil, this paper proposes a methodology for calibration of well chambers of users of high dose rate 192Ir sources, traceable to the International Ionizing Radiation Metrology Network. In the proposed method a thimble chamber is used, calibrated in LNMRI/IRD/CNEN (traceable to the International Ionizing Radiation Metrology Network) in X-ray and 60Co beams with an interpolation for the 192Ir energy. Using a positioning system to hold the chamber and a high dose rate 192Ir source, the quantity reference air kerma rate is determined. This radioactive source is then used to calibrate the user's chambers. The proposed methodology was tested in various radiotherapy services of the country and was also compared to the existing methodology in University of Wisconsin Accredited Dosimetry Calibration Laboratory (UWADCL)...

Intracoronary radionuclide therapy with liquid 188Re-filled balloons; radiopharmaceutical and dosimetric studies

Percutaneous transluminal coronary angioplasty associated with radioactive liquid-filled balloons has demostrated to be useful to inhibit the growth of neointimal tissue. The present study pursued optimizing the relation risk/benefit during a procedure of brachytherapy with 188Re associated to angioplasty. Since the possibility of balloon rupture exists, to increase the security during the treatment different agents such as 188Re-DTPA, 188Re-Citrate and 188Re-EC vs 188ReO4 were evaluated. Dosimetric studies using Mirdose 3, after iv injection to Wistar rats, evaluation of a number of safety requirements in order to estimate radiation dose delivered to operating personnel and absorbed doses estimated by Monte Carlo method (PENELOPE). It is a safe procedure, both for the patient and the working staff; in case of ballon rupture the use of the above mentioned radiopharmaceuticals increases its security. 188Re beta emitor achieves a local dosis, diminishing the dose in healthy tissue.

High-dose-rate-intracavitary brachytherapy applications and the difference in the bladder and rectum doses: a study from rural centre of Maharashatra, India.

AIM: To report the difference in the bladder and rectum doses with different applications by the radiotherapists in the same patient of the carcinoma of the uterine cervix treated by multiple fractions of high-dose-rate (HDR) intracavitary brachytherapy (ICBT). MATERIALS AND METHODS: Between January 2003 to December 2004, a total of 60 cases of the carcinoma uterine cervix were selected randomly for the retrospective analyses. All 60 cases were grouped in six groups according to the treating radiotherapist who did the HDR-ICBT application. Three radiotherapists were considered for this study, named A, B and C. Ten cases for each radiotherapist in whom all three applications were done by the same radiotherapist. And 10 cases for each radiotherapist with shared applications in the same patient (A+B, A+C and B+C). The bladder and rectal doses were calculated in reference to point "A" dose and were limited to 80% of prescribed point "A" dose, as per ICRU-38 recommendations. Received dose grouped in three groups--less then 80% (< 80%), 80-100% and above 100% (>100%). A total of 180 applications for 60 patients were calculated for the above analyses. RESULTS: There is a lot of difference in the bladder and rectal doses with the application by the different radiotherapists, even in the same patient with multiple fractions of HDR-ICBT. Applications by 'A' radiotherapist were within the limits in the self as well as in the shared groups more number of times, by 'B' radiotherapist was more times exceeding the limit and by 'C' radiotherapist doses were in between the A and B. DISCUSSION AND CONCLUSION: For the rectal and bladder doses most important factors are patient's age, disease stage, duration between EBRT and HDR-ICRT and patient anatomy, but these differences can be minimized to some extent by careful application, proper packing and proper fixation.

Endocavitary radiotherapy in carcinoma oesophagus.

Radiation therapy is often used in an attempt to palliate or cure oesophageal neoplasms. However, the radiation tolerance of the normal structures around the oesophagus (heart, lung and spinal cord) restricts the radiation dose that can be delivered. We used a nasogastric catheter to deliver High Dose Intra-luminal Iridium-192 irradiation for carcinoma of the oesophagus using HDR-Varisource machine. This technique for treatment of carcinoma of the oesophagus can help overcome the dose restraints. The external beam radiation dose was about 46 Gy and the intra luminal dose was 5 Gy at 1 cm from central axis. These after loading procedures are simple, fast and accurate and can be used to boost external radiation therapy doses. Since the intra luminal boost delivers a high-localized dose with little side effects, this simple technique should be used to obtain palliation, delay tumour progression, reduce overall treatment time and attempt to improve survival in patients with oesophageal neoplasm. Intra luminal brachytherapy helps achieve good palliation in these neoplasms.

Braquiterapia de alta taxa de dose no Brasil / High-dose rate brachytherapy in Brazil

A braquiterapia de alta taxa de dose foi introduzida em nosso meio em janeiro de 1991. Desde então, houve uma mudança significativa na abordagem das neoplasias malignas em relação às vantagens do novo método, e também resolução da demanda reprimida de braquiterapia para as neoplasias ginecológicas. Nos primeiros dez anos de atividade, o Brasil tratou, em 31 serviços, 26.436 pacientes com braquiterapia, sendo mais de 50 por cento das pacientes portadoras de neoplasias do colo uterino. Este estudo mostra o número e o perfil de pacientes tratados com esse método e a sua distribuição no território nacional, deixando explícito o benefício da braquiterapia de alta taxa de dose para o Brasil.

Braquiterapia intracoronariana. Tratamento da reestenose intra-stent com o sistema Beta-Cath: experiência inicial na América Latina / Intracoronary brachytherapy. Treatment of in-stent restenosis with the Beta-Cath system: initial experience in Latin America

OBJETIVO: Avaliar a segurança e eficácia da braquiterapia intracoronariana usando o sistema Beta-CathTM na prevenção da recorrência de restenose intra-stent (RIS), por meio da análise dos resultados clínicos, angiográficos e pelo ultra-som intracoronariano (USIC). MÉTODO: Foram submetidos à angioplastia com cateter-balão, seguida de beta-radiação intracoronariana com o sistema Beta-CathTM (90Sr/Y) 30 pacientes com RIS em artérias coronárias nativas e, posteriormente, avaliados. RESULTADOS: Incluíram-se lesões reestenóticas complexas (77 por cento do tipo difuso-proliferativo) com extensão elevada (18,66±4,15 mm). O sucesso da braquiterapia foi de 100 por cento. A dose média utilizada foi de 20,7±2,3 Gy, liberada em um período médio de 3,8±2,1 min. No seguimento tardio, o diâmetro luminal mínimo (DLM) intra-stent diminuiu discretamente (1,98±0,30mm para 1,84±0,39 aos 6 meses, p=0,13), com uma perda tardia de 0,14±0,18 mm. O DLM intra-segmentar foi significativamente menor do que o intra-stent (1,55±0,40mm vs.1,84±0,39mm, p=0,008), associando-se à perda tardia (0,40±0,29mm vs. 0,14±0,18mm; p=0,0001). No USIC, observou-se discreto incremento do tecido neointimal em 6,8±14,3 mm aos 6 meses (p=0,19) e a percentagem de obstrução volumétrica aumentou em 4,7±7,5 por cento. A reestenose binária e a revascularização do vaso-alvo recorreram em 17 por cento dos casos; houve 1 caso (3 por cento) de oclusão tardia, associada a infarto do miocárdio. A sobrevida livre de eventos foi de 80 por cento. CONCLUSAO: O manejo da reestenose intra-stent com a beta-radiação intracoronariana mostrou-se procedimento seguro e eficaz, com alta taxa de sucesso imediato, representando uma opção terapêutica para a inibição da hiperplasia neointimal.

Use of the Rectal Retractor to Reduce the Rectal Dose in High Dose Rate Intracavitary Brachytherapy for a Carcinoma of the Uterine Cervix

Commercially available rectal retractors can be used in high dose rate intracavitary brachytherapy (HDR ICR) as one of the methods for reducing the rectal dose in radiotherapy for a uterine cervical cancer. However, the extent of the rectal protection achieved using these rectal retractors has not been reported. The aim of the study was to examine the effect of a rectal retractor on reducing the rectal dose in HDR ICR. Thirty patients were treated with HDR ICR using rectal retractors. Tandem and ovoids were applied in 15 patients and ovoids only were used in the other 15 patients. During the simulation, the rectum was filled with barium, and anteroposterior and lateral radiographs were then taken with and without the rectal retractor. Along the anterior rectal wall outlined, 4 to 8 points (median 6) were chosen to calculate the dose for each patient including the rectal point (RP), which is an author-defined rectal point modified from the definition of the rectal reference point in the ICRU report 38. The length of the measured rectum was 3-7 cm (median 5 cm). The bladder point (BP) dose was measured as recommended by the ICRU. The prescription doses to point A varied from 3.5 to 5 Gy (median 4 Gy). Paired comparisons were made on the individual patients by calculating the normalized mean doses of the RP, the maximal point (MP), and the longitudinal average (LA) with and without the rectal retractor. The doses to the bladder points (BP) were also calculated in parallel to the rectal points. The anterior rectal walls were displaced posteriorly after inserting the rectal retractor. In the tandem and ovoids group, the number of patients with a reduced dose in the RP, MP and LA were 14 (93.3%), 12 (80.0%) and 13 (86.7%), respectively. In the ovoids only group, the corresponding figures were 14 (93.3%), 14 (93.3%) and 14 (93.3%). In the tandem and ovoids group, the reduced dose in the RP, MP, and LA dose were 0.52 Gy (13.0%), 0.50 Gy (12.5%), and 0.39 Gy (9.8%), respectively (p 0.05). The mean RP, MP, and LA dose reduction rates of the patient subgroup where the RP dose was 70%. The effect of the rectal dose reduction was significant only in the subgroup of patients who received > 70% of the prescription dose (p < 0.05). The use of the rectal retractor was a simple and an effective method for reducing the rectal dose. It was also considered to be a highly reproducible method, which can replace the time-consuming vaginal gauze packing in HDR-ICR.

Análises de protocolos de braquiterapia, por alta taxa de dose, do controle de qualidade de alguns serviços locais, baseados no TG40, TG56 e ARCAL XXX / Analysis of the high dose rate brachytherapy protocols of quality assurance programs of some local services, based on TG40, TG56 and ARCAL XXX

A braquiterapia por alta taxa de dose está recebendo atenção considerável na maioria dos países. Por isso, nos serviços que utilizam este equipamento exige-se que o desenvolvimento de um programa de controle de qualidade seja cada vez mais rigoroso, para garantir não apenas a segurança aos pacientes, mas também aos operadores e demais envolvidos. Este trabalho tem por objetivos fazer um levantamento dos tipos de testes para um equipamento de braquiterapia por alta taxa de dose, propostos pelos protocolos oficiais publicados (TG40, TG56 e ARCAL XXX) e avaliar os tipos de testes que atualmente são realizados por alguns serviços de radioterapia, comparando-os com aqueles apresentados nos protocolos citados. Das análises feitas, observou-se que: a) quanto aos protocolos oficiais, o TG56 é mais completo que o TG40 e o ARCAL XXX; b) quanto às instituições analisadas, estas em geral se basearam no TG56 para elaborar seus próprios protocolos, os quais demonstraram ter também concordância com os outros já citados. Nestes protocolos, a inexistência dos testes anuais foi notada, o que pode ser explicado por sua aparição nas freqüências trimestral e semestral. Do produto deste estudo são apresentadas tabelas dos tipos de testes com suas respectivas freqüências de utilização, das quais um protocolo pode ser inferido para auxiliar na implementação, pelo menos, dos tipos de testes de controle de qualidade básicos e indispensáveis para o equipamento, garantindo, assim, um tratamento adequado aos pacientes e uma melhor segurança ao pessoal envolvido e, conseqüentemente, assegurando a garantia de qualidade na braquiterapia por alta taxa de dose

High dose rate brachytherapy has been increasingly recognized in most countries, and radiotherapy services using this equipment are encouraged to have a very efficient quality assurance program to ensure protection for patients, workers and other personnel involved. The objective of this paper was to determine the types of tests for high dose rate equipment required by official protocols (TG40, TG56 and ARCAL XXX) and to compare them with the types of tests utilized by some radiotherapy services. We concluded that: a) the protocol TG56 is more extensive and complete than the other official protocols (TG40 and ARCAL XXX); b) the protocols used by the services evaluated on this study were based on the protocol TG56, and were concordant with the other official protocols. In these protocols annual tests were frequently replaced by tests performed quarterly or twice a year. This study established the types of test used and their frequency of utilization, and permitted the design of an optimized protocol that may help in the implementation of basic and indispensable tests in order to ensure patient adequate treatment and safety to personnel involved, and consequently improve high dose rate brachytherapy quality assurance.

Braquiterapia prostatica transperineal bajo control ecografico transrectal con semillas de iodo 125 en el tratamiento del cancer localizado de prostata / Transperineal ultrasound-guided i 125 prostatic brachytherapy for localized prostate cancer

Comunicamos nuestra experiencia preliminar y describimos la técnica quirúrgica de la braquiterapia prostática transperineal utilizando semillas de I 125 para el tratamiento del cáncer de próstata localizado. Veinticuatro pacientes fueron tratados con esta técnica con un seguimiento mínimo de 6 meses (6-25). La tolerancia fue excelente, el PSA bajó a niveles de normalidad en el 91,6 por ciento y por debajo de 1 ng/ml en el 40,9 por ciento. Dos pacientes presentaron metástasis al año del implante. Nuestra experiencia preliminar a corto plazo nos estimula a seguir a estos pacientes para establecer el rol de esta técnica en el tratamiento del carcinoma de próstata localizado

Evaluation of transperineal template implant technique in Indian cervical carcinoma patients.

The prognosis in advanced cervical cancer patients is poor specially in presence of distorted anatomy, gross residual growth etc. In these cases template implant offers good option for treatment. We have carried out the procedure in 19 patients with acceptable level of complication. Preliminary results have been described.

Calibracion en Maniqui de un equipo de alta tasa de dosis por carga remota / Calibration in a manikin of a high dose rate equipment by remote charge

El empleo de la braquiterapia de Alta Tasa de Dosis (HDR) en Cuba se ha enmarcado a las instalaciones de fabricacion sovietica AGAT-V. Con vista a la calibracion para su uso clinico de una de estas instalaciones, se desarrollo un procedimiento basado en la medicion directa de la dosis absorbida en punto de referencia B de un maniqui de parafina. Se muestran los resultados obtenidos de la calibracion. Se realizo a partir de estos la evaluacion de las dosis efectivas impartidas en punto de prescripcion A mediante el empleo del modelo Lineal-Cuadratico

Curieterapia endobronquial de alta tasa de dosis / Endobronchial curietherapy of high rate of doses

A pesar del avance en el tratamiento del cáncer pulmonar, el pronóstico continua siendo pobre. En 1991, las estadísticas de la American Cancer Society mostraron 152,000 muertes en 161,000 pacientes diagnosticados con cáncer pulmonar. El tratamiento con cirugía radical es posible en uno de cuatro pacientes. Los resultados deben ser tratados mediante radioterapia y quimioterapia. Para mejorar la sobrevida de estos enfermos, deben ensayarse nuevos métodos terapéuticos. Los tratamientos sistémicos tienen que ser probados junto con nuevas tentativas de tratamientos locales. En este trabajo se presenta una revisión sobre el papel de la curieterapia en el control de las enfermedades oncológicas

Braquiterapia intracavitária na neoplasia uterina / Intracavity brachitherapy in uterine neoplasia

O crescente uso de tratamento intracavitário em neoplasias uterinas näo tem sido acompanhado, em nossa literatura, por artigos que forneçam informaçöes básicas para consulta no dia a dia. Baseado neste fato, procuramos através deste trabalho, transmitir nossa experiência para realizaçäo da referida técnica terapêutica.

Braquiterapia de alta taxa de dose / High dose rate brachytherapy

A braquiterapia de alta taxa de dose utiliza fonte unica de '192 ANT. IND Ir' com atividade nominal inicial de 10Ci em equipamento com controle remoto. Esta tecnica permite que o tratamento seja realizado em regime ambulatorial, sem os inconvenientes da braquiterapia classica, como anestesia geral ou raquidiana, imobilizacao prolongada no leito e exposicao de pessoa a irradiacao. O servico de radioterapia possui cinco protocolos de tratamento em estudo: carcinoma de colo uterino, endometrio, pulmao, esofago e tumores do sistema nervoso central. Desde a instalacao do Micro Selectron HDR foram tratados 90 pacientes, com um total de 257 procedimentos. As aplicacoes sao semanais, perfazendo tres a quatro fracoes. Devido ao pouco tempo de atividade, os resultados sao preliminares, mas perfeitamente comparaveis aos primeiros meses dos tratamenos classicos. Nao tivemos nenhuma complicacao durante os procedimentos ou imediatamente apos. Muitos estudos devem ser realizados para se estabelecer criterios de dose, fracionamento e associacao ideais, a fim de se alcancar um alto nivel de taxa terapeutica.