brachytherapy

Brachytherapy

1. Brachytherapy

2. Defined as treatment of cancer by inserting radio-active sources into or near the tumor It is a type of Radiotherapy What is Brachytherapy ?

3. Radiation Therapy Treatment of malignant diseases by ionizing radiation Relatively a new specialty (Roentgen 1895) Technology oriented subject: rapid progress Modern RT: sophisticated and precise Heavy investment, regulatory authorities Medical fraternity : not very familiar

4. Radiation Therapy It is a localized form of treatment It is a prolonged/protracted Tt. (5-7 wks) It is easy to administer, specialized Tt. It is a painless procedure

5. Types of Radiotherapy Teletherapy or Ext. RT Cobalt: Radio-active source Linear Accelerator: X-ray source Brachytherapy Manual afterloading unit Remote afterloading Unit

6. Cobalt Teletherapy Unit

7. Linear Accelerator

8. Microselectron HDR Selectron LDR Microselectron PDR

9. Brachytherapy

10. Types of Brachytherapy It can be categorized in many ways Location of implant Type of loading Dose rate Duration of implant Type of emission

11. Types of Brachytherapy Location of implant Intracavitary : cervix, esophagus Interstitial : prostate, tongue Surface mold or Plaque : skin, palate, scalp

12. Types of Brachytherapy Duration Temporary: Source is taken out after the Rx uterus, breast Permanent: Permanently placed in the target Prostate, Brain

13. Types of Brachytherapy Method of delivery Manual loading: Radium needles Afterloading : Manual or Remote controlled

14. Types of Brachytherapy dose rate Low Dose Rate (LDR) = 0.4-2.0 Gy/hr Medium Dose Rate (MDR) = 2-12 Gy/hr High Dose Rate (HDR) = >12 Gy/hr

15. Microselectron HDR Selectron LDR Microselectron PDR

16. ADVANTAGES OF BRACHYTHERAPY A high localized radiation dose to a small volume --higher local control Spares surrounding normal organs and tissues leading to less side effects Ultimate form of conformal radiotherapy Shorter treatment time-convenient, prevents tumor proliferation Nonhomogenous dose distribution to tumor targeting the hypoxic central core

17. EBRT Brachytherapy Prolonged Treatment (wks) Short duration (hrs) OPD procedure Indoor Non-invasive Invasive Painless Analgesia required Tumor size : any Small Simple Treatment Skilled Normal tissue dose Minimal Body movements: problem Negligible Common use alone Often combined with EBRT Widely available Limited availability Heavy & costly equipment Small, cheaper

18. Breachytherapy : Team work Brachytherapist Anesthesiologist Medical Physicist Staff nurse

19. Brachytherapy Facilities in India Radiotherapy Centres : 357 Teletherapy Facilities : 533 Brachytherapy Facilities : 343 Remote Afterloading Units (HDR/MDR/LDR) : 227 Manual Afterloading Brachytherapy facilities : 116

20. Common Indications Prostate Cervix Breast Head & Neck Sarcomas Esophagus Ano-Rectum

21. BRACHYTHERAPY IN CARCINOMA CERVIX

22. BRACHYTHERAPY TYPES IN CA CERVIX Intracavitary radiotherapy (ICRT) Interstitial brachytherapy

23. A COMPLETED HDR ICRT APPLICATION

24. SIMULATION Markers Markers Orthogonal radiographs

25. COMPLETED TEMPLATE

26. IMAGING

27. Bladder Target Rectum

28. TREATMENT DELIVERY

29. Fig. 1 b a

30. Role of Brachytherapy in Ca Breast

31. Role of Brachytherapy in Ca Breast As boost treatment in BCT : After a dose of 45-50 Gy with EBRT to the whole breast, boost dose of 15-20 Gy is delivered by brachytherapy As sole modality of treatment : As sole modality of treatment - an alternative to standard BCT in selected patients For treatment of Chest wall recurrences : Chest wall irradiation with a moulded cast/interstitial implantation LABC (inoperable):

32. Brachytherapy in Head and neck cancer

33. Brachytherapy in Ca Prostate

34. STEPS: Planning- TRUS guided volume study—computer preplan Brachytherapy procedure -TRUS guided trans perineal needle-.. peripheral loading.. seeds placed along the tract from base to apex. Post implant evaluation -by CT scan

35. Intra-operative Brachytherapy

36. Gliasite Brachytherapy

37. Skin Cancer

38. Surface Brachytherapy

39. Brachytherapy effect

40. Role of Nursing in RT/Brachytherapy Clinical care : Communication; medical care; psychosocial care Teaching Research

41. Role of Nursing in RT/Brachytherapy Outdoor pts Indoor pts For management of pts undergoing RT For planned brachytherapy/IORT procedures

42. Role of Nursing in RT Familiar with the usual course of RT Instruction, precautions during RT Knowledge of radiation safety Any emergency

43. Nursing care for brachytherapy Limit time in pt room Limit visitors to 30 minutes at a 6 foot distance Post radiation signs on door No young children or pregnant women Nurses wear radiation badge Follow policies of radiation dept

44. Conclusion Brachytherapy is highly precise and accurate form of RT Can be done for almost every cancer site Small tumors are ideal lesions for cure Large lesions are treated by brachytherapy + EBRT Knowledge of brachytherapy is essential for oncology nurses

45. Thank You