CT-image based conformal high-dose-rate brachytherapy boost in the conservative treatment of stage I – II breast cancer – introducing the procedure

The role of high-dose-rate brachytherapy boost in breast-conserving therapy: Long-term results of the Hungarian National Institute of Oncology

“…5,[8][9][10][11][12][13][14][15]34 Later, HDR BT was also accepted as a safe alternative boost modality (Table 6). 4,6,7,12,[16][17][18][19][20][21][22][23][24][25][26][27]34 Only a few reports have compared the outcome in patients treated with BT or external beam boost. 6,7,[9][10][11][12][13][14][15]20,21,25,35,36 In the majority of these studies similar local control and cosmetic results have been reported for women boosted either with interstitial implants or electrons/photons.…”

“…4,5,[8][9][10][11][12][13][14][15] Later, highdose-rate (HDR) BT has also been accepted as a safe alternative boost modality. 6,7,12,[16][17][18][19][20][21][22][23][24][25][26][27] …”

CT-Image Guided Brachytherapy

“…At present there are several techniques used in maintaining better coverage of the target volume. However, the irregular 3-D shape of the excision cavity and the normal tissue structures can only be accurately localized by visual information acquired from cross-sectional imaging (Kubaszewska et al, 2008). The use of surgical clips and CT at the same time seems to be the best method to determine the target volume, since both titanium clips and borders of the excision cavity can be visualized exactly from slice to slice (Polgar et al, 2000).…”

“…The skin dose should not exceed 60% of prescribed dose (executed only in case of a superficial plane implanted at least 10 mm from the skin). In the 3D treatment planning based on CT sectional-cross the main aspect is to achieve such dose distribution, where all surgical clips would receive at least 85 % of the prescribed dose (Kubaszewska et al, 2008). Planning concepts are based on the 3D reconstruction of the catheters, tumor bed clips maintaining proper distances (at least 10 mm) from critical structures (skin, ribs).…”

“…The active source positions, dwell times and reference dose points are defined individually in each catheter as well as dose optimization. To avoid skin and rib injury, the most peripheral active source positions are kept at a minimum of 10 mm distance from the skin and rib surface (Kubaszewska et al, 2008). Polgar et al compared the conventional 2D, the simulator-guided semi 3D and the recently developed CT-guided 3D brachytherapy treatment planning in the interstitial radiotherapy of breast cancer.…”