A brief history of contact X-ray brachytherapy 50 kVp.

Contact X ray brachytherapy 50 kVp was initiated in the 1930s with the Siemens unit and popularized with the Philips unit in the 1950s. A renaissance was seen in the early 2000s with the Intrabeam™ unit for breast IORT. Presently the Papillon™ systems thanks to its high dose rate (>10Gy/mn) can be used to treat breast (IORT), skin, eyelid and rectal cancers. Future developments are expected to consolidate the place of contact radiotherapy as a safe and efficient treatment for accessible early tumors.

The evolution of brachytherapy for prostate cancer.

Brachytherapy (BT), using low-dose-rate (LDR) permanent seed implantation or high-dose-rate (HDR) temporary source implantation, is an acceptable treatment option for select patients with prostate cancer of any risk group. The benefits of HDR-BT over LDR-BT include the ability to use the same source for other cancers, lower operator dependence, and - typically - fewer acute irritative symptoms. By contrast, the benefits of LDR-BT include more favourable scheduling logistics, lower initial capital equipment costs, no need for a shielded room, completion in a single implant, and more robust data from clinical trials. Prospective reports comparing HDR-BT and LDR-BT to each other or to other treatment options (such as external beam radiotherapy (EBRT) or surgery) suggest similar outcomes. The 5-year freedom from biochemical failure rates for patients with low-risk, intermediate-risk, and high-risk disease are >85%, 69-97%, and 63-80%, respectively. Brachytherapy with EBRT (versus brachytherapy alone) is an appropriate approach in select patients with intermediate-risk and high-risk disease. The 10-year rates of overall survival, distant metastasis, and cancer-specific mortality are >85%, <10%, and <5%, respectively. Grade 3-4 toxicities associated with HDR-BT and LDR-BT are rare, at <4% in most series, and quality of life is improved in patients who receive brachytherapy compared with those who undergo surgery.

[Historical overview and the current practice of intracavitary treatment of cervical and endometrial cancer in the Oncoradiology Center of Budapest]. / A méhtest- és méhnyakrák intrakavitális kezelésének történeti áttekintése és jelen gyakorlata a Fõvárosi Onkoradiológiai Központban.

The aims of our study were to describe the history and development of intracavitary brachytherapy in the treatment of gynecological tumors, to introduce our current practice for intracavitary brachytherapy treatments based on CT planning. Gynecological intracavitary brachytherapy has been applied in our department since the early 1930s. After a long development it has been completely renewed by 2014. In our center definitive and/or preoperative gynecological HDR-AL brachytherapy treatments were given to 25 patients (13 corpus uterine cancer patients and 12 cervical cancer patients) during the period of 01. 01. 2014-31. 01. 2015. In each case, target volumes were planned by CT images, DVH (dose volume histogram) analysis was performed in order to calculate the radiation tolerance dose of rectum and urinary bladder. Evaluation was performed by the EclipseTM 11.0.47. brachytherapy treatment planning system. During the definitive treatments of the 13 uterine cancer patients the D2cc value related to rectum tolerance was 66.3 GyEQD2 (46-91 Gy). The average D2cc value of urinary bladder tolerance was 76.5 GyEQD2 (30-112 Gy). CI was 0.72 (0.6-0.95). Average value of COIN was 0.57 (0.35-0.78). Compared to the prescribed dose D100 and D90 values were given in ratios. Compared to the volume which receives 100% of reference dose V150 and V200 values were also given in ratios. D100 and D90 were calculated to be 0.66 (0.47-0.97) and 0.91 (0.8-1.25). V150 and V200 volumes were 0.11 (0.04-0.18) and 0.06 (0.02-0.1). During the definitive treatments of 12 cervical cancer patients the D2cc value related to rectum tolerance calculated by DVH was 75.2 GyEQD2 (60-82 Gy). The average D2cc value of urinary bladder tolerance was 85 GyEQD2 based on DVH. CI was 0.66 (0.42-0.76). Average value of COIN was 0.52 (0.32-0.78). Mean value of DHI was 0.46 (0.27-0.54). D100 and D90 were calculated to be 0.72 (0.57-0.89) and 0.91 (0.84-1.11). V150 and V200 volumes were 0.057 (0.02-0.13) and 0.02 (0.002-0.06). During treatments no severe side effects were found. During gynecological intracavitary HDR therapies the calculated dose of the target volume can be given safely using the EclipseTM 11.0.47. brachytherapy planning system and CT-based planning. CT-based treatment planning provides optimal safety for organs at risk, acceptable doses for rectum and urinary bladder while the target volume receives the proper prescribed dose.

Afterloading: The Technique That Rescued Brachytherapy.

Although brachytherapy had been established as a highly effective modality for the treatment of cancer, its application was threatened by mid-20th century due to appreciation of the radiation hazard to health care workers. This review examines how the introduction of afterloading eliminated exposure and ushered in a brachytherapy renaissance.

Introduction of transperineal image-guided prostate brachytherapy.

The modern prostate brachytherapy procedure is characterized by ultrasound guidance, template assistance, and a return to a "closed" transperineal approach. This review traces the introduction and evolution of these elements and charts the development of the procedure from the ashes of previous, failed efforts.

Future directions from past experience: a century of prostate radiotherapy.

Prostate cancer is the most commonly diagnosed noncutaneous malignancy in men, yet 100 years ago it was considered a rare disease. Over the past century, radiation therapy has evolved from a radium source placed in the urethra to today's advanced proton therapy delivered by only a few specialized centers. As techniques in radiation have evolved, the treatment of localized prostate cancer has become one of the most debated topics in oncology. Today, patients with prostate cancer must often make a difficult decision between multiple treatment modalities, each with the risk of permanent sequelae, without robust randomized data to compare every treatment option. Meanwhile, opinions of urologists and radiation oncologists about the risks and benefits involved with each modality vary widely. Further complicating the issue is rapidly advancing technology which often outpaces clinical data. This article represents a complete description of the evolution of prostate cancer radiation therapy with the goal of illuminating the historical basis for current challenges facing oncologists and their patients.

[The early development of brachytherapy of the prostate: a study on technique application in the development of urology]. / Zur frühen Entwicklung der Brachytherapie der Prostata : Eine Studie zur Technikanwendung in der Urologieentwicklung.

Within recent years brachytherapy of the prostate has become a treatment of choice. The treatment can be dated back up to the beginning of the twentieth century. It is interesting that the urological routes have never been explored directly by authors of articles and textbooks in the field of radiology and radiooncology.

[Technical and methodical developments of radiation oncology from a physician's point of view]. / Die technischen und methodischen Entwicklungen der Radioonkologie aus ärztlicher Sicht.

Technical and methodical developments have changed radiation oncology substantially over the last 40 years. Modern imaging methods, e.g., computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and ultrasound (US), have not only improved the detection of tumors but have also become tools for computed treatment planning. Megavoltage irradiation with accelerators using photons and electrons with large and small fields, intensity modulation (IMRT), image-guided radiotherapy (IGRT), stereotactic irradiation and radiosurgery, intraoperative radiotherapy (IORT), and modern remote controlled afterloading brachytherapy have made high precision radiotherapy increasingly possible. Hadron therapy has potential for further developments. Radiation oncology today is an interdisciplinary modality and increasingly considers interactions with new drugs and differentiated surgical methods. There is a strong need for comprehensive evaluation of the new methods and also for translational research in biology of tumors and normal tissue biology as well as in medical physics and techniques.

Robert Abbe: early American brachytherapist.

PURPOSE: To assess Robert Abbe's career and contributions to brachytherapy, in the context of the work of contemporary European and American investigators. METHODS AND MATERIALS: Examination of his lectures and journal articles, as well as contemporaneous newspaper accounts, textbooks, and archival material. RESULTS: Although not the first American to apply radium therapeutically, Robert Abbe was among the earliest to acquire and systematically use a clinically significant quantity. He replicated early European experimental and clinical work, and published a large series of cases treated with generally favorable results. Abbe was the first American to emphasize the role of radiobiology in optimizing therapeutic ratio. His eloquence and stature helped legitimize the new therapeutic modality. CONCLUSIONS: Robert Abbe was probably the nation's most influential early brachytherapist.

From the lost radium files: misadventures in the absence of training, regulation, and accountability.

PURPOSE: Radium was the foundation of brachytherapy in the early decades of the 20th century. Despite being a most precious and perilous substance, it was mislaid with surprising frequency. This essay explores how it was lost, the efforts taken to recover it, and measures instituted to prevent mishandling. METHODS AND MATERIALS: Review of contemporary literature, government publications, archives, and lay press. RESULTS: Radium is a particularly dangerous substance because of its long half-life, its gaseous daughter (radon), and the high-energy emissions of its decay products. Despite the hazard, it was unregulated for most of the century. Any physician could obtain and administer it, and protocols for safe handling were generally lacking. Change came with appreciation of the danger, regulation, mandated training, and the institution of a culture of accountability. Unfortunately, careless management of medical radionuclides remains a global hazard. CONCLUSION: Responsible stewardship of radioactive material was not a high priority, for practitioners or the federal government, for much of the 20th century. As a result, large quantities of radium had gone astray, possibly subjecting the general public to continued radiation exposure. Lessons from the radium era remain relevant, as medical radionuclides are still mishandled.

Development of the M. D. Anderson Cancer Center gynecologic applicators for the treatment of cervical cancer: historical analysis.

PURPOSE: To provide historical background on the development and initial studies of the gynecological (gyn) applicators developed by Dr. Gilbert H. Fletcher, a radiation oncologist and chairperson from 1948 to 1981 of the department at the M.D. Anderson Hospital (MDAH) for Cancer Research in Houston, TX, and to acknowledge the previously unrecognized contribution that Dr. Leonard G. Grimmett, a radiation physicist and chairperson from 1949 to 1951 of the physics department at MDAH, made to the development of the gynecological applicators. METHODS AND MATERIALS: We reviewed archival materials from the Historical Resource Center and from the Department of Radiation Physics at The University of Texas M. D. Anderson Cancer Center, as well as contemporary published papers, to trace the history of the applicators. CONCLUSIONS: Dr. Fletcher's work was influenced by the work on gynecologic applicators in the 1940s in Europe, especially work done at the Royal Cancer Hospital in London. Those efforts influenced not only Dr. Fletcher's approach to the design of the applicators but also the methods used to perform in vivo measurements and determine the dose distribution. Much of the initial development of the dosimetry techniques and measurements at MDAH were carried out by Dr. Grimmett.

Whitmore, Henschke, and Hilaris: The reorientation of prostate brachytherapy (1970-1987).

PURPOSE: Urologists had performed prostate brachytherapy for decades before New York's Memorial Hospital retropubic program. This paper explores the contribution of Willet Whitmore, Ulrich Henschke, Basil Hilaris, and Memorial's physicists to the evolution of the procedure. METHODS AND MATERIALS: Literature review and interviews with program participants. RESULTS: More than 1000 retropubic implants were performed at Memorial between 1970 and 1987. Unlike previous efforts, Memorial's program benefited from the participation of three disciplines in its conception and execution. CONCLUSIONS: Memorial's retropubic program was a collaboration of urologists, radiation therapists, and physicists. Their approach focused greater attention on dosimetry and radiation safety, and served as a template for subsequent prostate brachytherapy programs.

Historia de la estereotaxia, la braquiterapia y la radiocirugía en Cuba / History of the stereotaxis, the brachitherapy and the radiosurgery in Cuba

La neurocirugía estereotáxica se basa en un sistema de coordenadas cartesianas x, y, z, para la localización tridimensional de un target intracraneal. Se introduce en Cuba en 1955 mediante un sistema de Cooper, y evoluciona posteriormente con el desarrollo de las técnicas de imágenes y de los softwares de computación. En los inicios de la década de los setenta comienza en el Instituto de Neurología y Neurocirugía la talamotomía en pacientes parkinsonianos y la lesión del núcleo centromediano en pacientes con neuralgia trigeminal guiados por yodo y neumoventriculografia. La biopsia guiada por tomografía axial computarizada, la braquiterapia intersticial e intracavitaria se introducen por primera vez en Cuba en el Hospital Clínico Quirúrgico Hermanos Amejeiras en diciembre de 1990, así como la radiocirugía a partir de 1991 en 24 pacientes (11 tumores y 13 MAV). La lesionotomía en trastornos de movimiento se inicia en el Centro Internacional de Restauración Neurológica en 1991 (pálido y subtalamotomía), así como la resección volumétrica de lesiones intracraneales. En 1997, se fabrica en el este centro el ESTEREOFLEX, primer marco estereotáxico cubano, que lleva la estereotaxia a varios provincias del país. En el año 2010, el hospital Hermanos Amejeiras y el Centro de Neurociencias introducen la tractografía para la resección estereotáxica de lesiones en áreas elocuentes. Igualmente, se inicia en esta fecha en el mencionado hospital la cirugía endoport o brainport para resección endoscópica, guiada por estereotaxia de tumores pineales. En la etapa 2010-2011 se reinicia la radiocirugía estereotáxica tanto en el hospital Hermanos Amejeiras como en el Instituto Nacional de Oncología y Radiobiología(AU)

The stereotactic neurosurgery is based in the system of Cartesian coordinates x, y, z, for the three-dimensional localization of an intracranial target. It was introduced in Cuba in 1955 through a Cooper system, and later evolved with the imaging techniques and computerized software. At the beginnings of the seventies, the staff of the Institute of Neurology and Neurosurgery began to use the thalamotomy in Parkisonian patients and the lesion of the centromedial nucleus in patients with trigeminal neuralgia guided by iodine and pneumoventriculography. The biopsy guided by computerized axial tomography, the interstitial and intracavity brachitherapy were introduced for the first time in the Clinical-Surgical Hospital Hermanos Amejeiras in December 1990, and also the radiosurgery since 1991 in 24 patients (11 tumors and 13 MAV). The lesionotomy in movement disorders began at the International Centre of Neurological Restoration in 1991 (pallidus and subthalamotomy), and also the volumetric resection of the intracranial lesions. In 1997, they made the ESTEREOFLEX in this centre, the first stereotactic frame, allowing to make the stereotaxis in several provinces of the country. In 2010, the hospital Hermanos Amejeiras and the centre of neurosciences introduced the tractography for the stereotactic resection in eloquent areas. Also in that date they began to make, in the above-mentioned hospital, the endoport or brainport surgery for endoscopic resection, guided for stereotaxis of pineal tumors. In the years 2010-2011 the stereotactic neurosurgery is retaken as much in the hospital Hermanos Amejeiras as in the National Institute of Oncology and Radiobiology(AU)