Paradigm Shift in Radiation Treatment Planning Over Multiple Treatment Modalities.

The inverse planning simulated annealing optimization engine was used to develop a new method of incorporating biological parameters into radiation treatment planning. This method integrates optimization of a radiation schedule over multiple types of delivery methods into a single algorithm. We demonstrate a general procedure of incorporating a functional biological dose model into the calculation of physical dose prescriptions. This paradigm differs from current practice in that it combines biology-informed dose constraints with a physical dose optimizer allowing for the comparison of treatment plans across multiple different radiation types and fractionation schemes.

Brachytherapy Future Directions.

Brachytherapy has advanced dramatically in the last decade due largely to improvements in applicators, imaging, treatment planning, and use of clinical trials. In addition, current research in brachytherapy technology continues to change how we deliver this treatment modality. The future of brachytherapy lies in the ability of new technologies to overcome real or perceived barriers. The focus for this manuscript is on specific tools that have or are near to being introduced in the clinic. First, we explore the impact electromagnetic tracking technologies can have on brachytherapy implants and planning workflow. This is followed by an overview of the use of 3D printing and its ability to help tailor brachytherapy implants. Next, we discuss advances in self-shielded applicators and intensity-modulated brachytherapy technology. The manuscript closes out with 2 sections on treatment planning. First is a discussion of biological optimization and its potential as compared with current techniques (eg, based on physical dosimetry). And lastly, a section on optimization treatment planning efficiencies in which we explore the potential for machine learning in brachytherapy. As recent clinical evidence continues to show excellent outcomes, this is an exciting time to practice brachytherapy. With the new technologies presented here, the future is even brighter.