Oesophageal brachytherapy
• Esophageal brachytherapy can be offered as a palliative procedure for symptomatic relief of obstruction in oesophageal cancer.
• Clinical evidence shows that compared to stent placement brachytherapy has less complication and better long-term relief of symptoms.
• In non-metastatic patients who refuse radical surgery, esophageal brachytherapy can be offered as a radiation boost in addition to definitive external beam radiotherapy [EBRT].
Prostate brachytherapy
•High-dose rate(HDR) interstitial brachytherapy is an option in the treatment of localized prostate cancer either on its own or in combination with external beam radiotherapy.
•The radiotherapy control rate of prostate cancer shown to be equivalent to surgery in the literature albeit different toxicity profile.
•HDR interstitial brachytherapy also plays a strong role in treating isolated recurrences in the prostate or prostatic bade after primary treatment with surgery or external beam irradiation.
Fiducials for prostate cancer
•Fiducial markers (usually 3 gold seeds) are inserted under transrectal ultrasound guidance for accurate targeting of the prostate during external beam radiotherapy.
•With fiducial markers, the degree of uncertainty of the target position can be markedly reduced.
Palliative HDR brachytherapy
•High-dose rate(HDR) interstitial brachytherapy can be used as a palliative modality to control local tumor and improve the quality of life.
•It is useful especially in the setting of reirradiation whereby the tolerance of surrounding tissue can be an issue if using external beam radiotherapy [EBRT].
HDR brachytherapy for pelvic recurrence
•Transperineal high-dose rate(HDR) interstitial brachytherapy can be used to treat in operable pelvic recurrences with curative aim.
•These pelvic recurrences are commonly from rectal and anal canal cancers and at times can be sarcoma or gynecological cancers.
Rectal HDR brachytherapy
•High-dose rate(HDR) brachytherapy with the use of specialized a channel intraluminal brachytherapy applicator is a method to further boost the dose of radiation to residual tumor in the rectum.
•This procedure is useful to induce complete response of tumors in the rectum for patients who refused surgery or unfit for surgery.
Lung HDR brachytherapy
•Interstitial high-dose rate(HDR) brachytherapy for lung lesions is a palliative option to control the local lesion especially when the tumor is heavily pretreated and in the radioresistant and chemo resistant face.
•Very rarely, HDR interstitial brachytherapy of the lung can be used in definitive curative setting.
HDR brachytherapy of breast
High-dose rate(HDR) interstitial brachytherapy of the breast can be used in:
•As a boost to the tumor bed after breast conserving surgery, with or without external beam radiotherapy
•In definitive curative setting to induce complete tumor response when patient refused surgery
•In palliative setting to control the local tumor and improve quality of life