vLDR brachytherapy: Our grandfather's brachytherapy revisited—Optimized and improved.
Authors: Arnold M. Herskovic, Colon Orton, Ashley Distler, Mark Rivard, Paul J. Chuba
Journal: Journal of Clinical Oncology (2014)

Article Tools Tumor Biology Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/jco.2014.32.15_suppl.e22240 Journal of Clinical Oncology - published online before print May 20, 2014 vLDR brachytherapy: Our grandfather's brachytherapy revisited—Optimized and improved. Arnold M. HerskovicxArnold M. HerskovicSearch for articles by this author , Colon OrtonxColon OrtonSearch for articles by this author , Ashley DistlerxAshley DistlerSearch for articles by this author , Mark RivardxMark RivardSearch for articles by this author , Paul J. ChubaxPaul J. ChubaSearch for articles by this author Show More Rush University Medical Center, Chicago, IL; Wayne State University, Detroit, MI; Presence Health System, Chicago, IL; Tufts University, Medford, MA; St. John Providence Webber Cancer Center, Warren, MI Abstract Disclosures https://doi.org/10.1200/jco.2014.32.15_suppl.e22240 Abstract Abstract e22240 Background: Radiobiologic investigators believe that continuous very low dosr rate radiation (approximately <30cGy per hours as in "seed brachytherapy" offers a better therapeutic ratio for the treatment of selected carcinomas consistent with the clinical impression documenting tolerance to high physical doses and treatment efficacy. Methods: Comparisons were made between conventional more common radio therapeutic modalities and the proposed tools as to: physical optimization minimizing the exposure to collateral tissues; biological optimization: to tailor the deliverd treatments bioloigcally; as well as optimizing the costs. An assortment of clinical situations are presented. Results: Physical optimization: The alternative external radiation delivery systems even including stereotactic radiotherapy, protons, etc. all have a disadvantage in that collateral normal tissue is also exposed; whereas, an emitting radiation source localized within a tumor target delivers a much smaller volume exponentially decreasing the dose to collaterally exposed tissues. Biological optimization: Isotope selection can be optimized by various well-defined radiobioloigcal parameter in both the target and collateral tissues. Concern regarding radiation exposure to family, staff need for capital purchases, great sensitivity to implant geometry have limited brachytherapy utilization, but new optimization strategies justifies renewed interest. In specific applications minimal shielding aand capital purchases are required as are fewer procdures and interuption of other treatments such as chemotherapy optimized biological and fiscal costs. Actual costs vary, but all estimates suggest a savings of at least a third. In one scenario Medicare base costs of $3,300 compared to approximately $10,000 for SBRT, HDR (10 treatments), $6,300 for accelerated external beam radio therapy treatments plus other costs, equipment, radioactive sources, surgical and endoscopic charges needed to be included, but still favor vLDR brachytherapy Conclusions: The challenges can be met. Evolutionary optimization of vLDR brachytherapy offers the clinician a valuable tool that can best serve our patients needs in selected circumstances. © 2014 by American Society of Clinical Oncology