This section is designed to offer health care providers a general outline of brachytherapy applications. For more information and specific study results, please see the articles referenced.
Breast conservation treatment has long since been established as an effective treatment alternative to mastectomy for early stage breast cancer. Standard breast conservation treatment consists of breast conserving surgery for tumor removal (lumpectomy) followed by external radiation to the whole breast. Although this treatment approach offers many advantages over mastectomy and provides in-breast cancer control rates that approach 95-100% with good to excellent cosmetic results in nearly all patients, six weeks of daily treatment has proved prohibitive for some patients. As a result, some women refuse external radiation (putting themselves at higher risk for recurrence) or choose mastectomy and have the breast unnecessarily removed. Those finding six weeks of daily treatment inconvenient or impossible include working women, elderly patients, and those who live a significant distance from a treatment center. Breast brachytherapy as the sole method of radiation following lumpectomy is a new treatment approach that offers equivalent local control, breast conservation and improved convenience of treatment delivery. Although most women with breast cancer are appropriate candidates for standard breast conservation treatment and can be treated with lumpectomy and external radiation, only a subgroup of these women will be appropriate candidates for breast brachytherapy. However, even with strict selection criteria it is estimated that 71,000 women each year would be appropriate candidates for breast brachytherapy.
The ABS has issued guidelines for the use of brachytherapy for the treatment of breast cancer. For specific study information and guidelines, please see Oncology, Vol. 15, No. 2 (February 2001). In this publication, we reviewed the use of breast brachytherapy as boost treatment, for the treatment of in-breast recurrences and as the sole modality following lumpectomy. Although the majority has remained unchanged, the consensus on the role of brachytherapy as the sole method of radiotherapy has been altered to reflect recent findings in the published literature. At the time of publication, "brachytherapy as a sole modality is to be considered investigational and should be performed in the context of a controlled clinical trial." Based on recent clinical publications the ABS now considers accelerated partial breast irradiation an appropriate alternative to standard whole breast radiotherapy in appropriately selected patients. Details have been prepared and a manuscript has been submitted for publication.
In the treatment of cervical cancer, brachytherapy has historically provided a successful alternative to surgery. The ABS has issued guidelines for both high-dose-rate (HDR) brachytherapy and low-dose-rate (LDR) brachytherapy in conjunction with external beam radiation therapy in order to reduce recurrence of cancer and complications associated with treatment. For specific study information and practice guidelines, please see the International Journal of Radiation Oncology Biology Physics, Vol. 48, No.1, pp 201-211, 2000, and Vol. 52, No. 1, pp 33-48, 2002.
Brachytherapy has several different applications in the treatment of cancer of the endometrium. The ABS has endorsed the recommendations made by the National Comprehensive Cancer Network for the indications to use HDR brachytherapy in the treatment of cancer of the endometrium, as well as the American Association of Physicists in Medicine guidelines on HDR quality assurance. The ABS has issued specific guidelines for technique as well as the application of brachytherapy in inoperable or recurring cancer of the endometrium. For specific study information and practice guidelines, please see the International Journal of Radiation Oncology Biology Physics, Vol. 48, No. 3, pp 779-790, 2000.
The ABS has developed specific treatment guidelines for the use of brachytherapy in the definitive and palliative treatment of esophageal cancer, including the identification of appropriate candidates and combination therapies. For specific study information and practice guidelines, please see the International Journal of Radiation Oncology Biology Physics, Vol. 38, No. 1, pp 127-132, 1997.
The use of brachytherapy in the treatment of head and neck cancers causes practitioners hesitation, owing to the proximity to vital structures including the carotid arteries, the jugular veins, other major blood vessels and in some cases the brain. There is a limited amount of clinical data available but, there are several safe and efficacious ways to use brachytherapy in the treatment of head and neck cancers. For specific study information and practice guidelines, please see the International Journal of Radiation Oncology Biology Physics, Vol. 50, No. 5, pp 1190-1198, 2001.
Early clinical studies indicate that intravascular brachytherapy can help reduce the rate of restenosis after angioplasty procedures. Based on these results, devices for intracoronary brachytherapy have been approved by the FDA for widespread use. The ABS recommends further testing and the development of treatment guidelines. For more information, please see Cardiovascular Radiation Medicine, Vol. 1, No. 1 pp 8-19, 1999.
The use of brachytherapy in the treatment of lung cancer dates to the 1920s, though the applications varied widely. The ABS developed guidelines for the use of brachytherapy as a combination therapy and as a stand-alone therapy for the treatment of lung cancer. For specific study information, please see Oncology, Vol. 15, No. 3 (March 2001).
Brachytherapy has many applications in the treatment of prostate cancer. In the setting of early stage favorable prostate cancer, it has been proven safe and effective, with 10-year survival rates that appear comparable to survival rates observed following radical prostatectomy. For specific study information, please see the International Journal of Radiation Oncology Biology Physics, Vol. 1, No. 5, pp 1422-1430, 2001.
Brachytherapy can be used alone or in combination with external beam radiation therapy for soft tissue sarcomas as an effective means to enhance therapeutic ratio (ratio of effectiveness when compared to toxicity of treatment). The ABS developed guidelines for the use of brachytherapy in the treatment of soft-tissue sarcoma. For specific study information, please see the International Journal of Radiation Oncology Biology Physics, Vol. 49, No. 4, pp 1033-1043, 2001.
