Radiation Oncology

INTERSTITIAL BRACHYTHERAPY UNIT



Brachytherapy directs high-dose X-Rays internally, targeting the tumor with great precision and without causing any damage to surrounding, healthy tissues. This internal intervention with implants is exactly what differentiates this method from external radiation therapy.

Practically, this means that Brachytherapy, in the way that it has been developed by Professor Zamboglou and his multi-thematic team of scientists in Germany for a period of almost 25 years, can target the tumor with great precision and blast it with much higher doses of radiation that external radiotherapy can use. These high doses are necessary in order to achieve local control of the cancer. In specific case, this method may be used either independently, or in combination with external radiotherapy.

Over the years, this method, as it is practiced now at the German Oncology Center, has yielded remarkable results in treating prostate, cervical and breast cancers. Results, which have been published in recognized and respected medical journals worldwide.

HOW IS BRACHYTHERAPY PERFORMED?


In high dose rate brachytherapy (HDR – Brachytherapy), which is offered at the GOC, we place guided catheters into pre-located positions inside or very close to the tumor so that the radioactive source Ir192 can be administered to the patient. This procedure is always carried out under the guidance/navigation of an ultrasound or CT Scan.

Once the comprehensive dosimetric plan, which specifies exactly where the catheter needles must be placed and how long should they remain in the patient, the catheters are then connected to an applicator and attached to a computer controlled machine, known as an afterloader.

The afterloader sends small radiation sources down the applicator and catheters delivering highly conformal doses with steep dose gradients to tumors that are not surgically resectable, mainly because of the close proximity to critical organs. The radiation sources are then left in place for a predetermined period of time.

The computer is programmed to control very accurately where the radiation is delivered and how long it remains in the organ. This ensures that a very precise and accurate dose of radiation is delivered to the tumor.

This procedure is carried out in special units which are radioactive-protected, the patient is alone but is observed via camera by the doctor and a medical physicist.

Once radiation has been delivered, the catheters are removed, if only one session has been decided, or remain implanted if the patient is programmed to repeat the treatment shortly.


How the radiation dose is distributed internally

WHICH CANCERS CAN BE TREATED WITH BRACHYTHERAPY?



Interstitial brachytherapy (IB) is an effective treatment for many types of cancer, whether for full healing, or for palliative care. Scientific results have shown that in many cases IB can be applied either as an alternative method to surgery and external radiotherapy or in combination with them. Its most important advantage however is that it has very few side-effects, mainly because radiation is administered in a targeted way directly into the tumor, without traumatizing neighboring tissues.

The radioactive source which is directed via catheters into the tumours, is the radioactive Iridium 192, which is why we use the term Iridium Knife.


Indications:

  • Prostate Cancer
  • Breast Cancer
  • Cervical Cancer
  • Palliative Care
Prostate Cancer

Interstitial brachytherapy is a scientifically recognized alternative solution for surgically removing the prostate tumor, or applying a series of radiotherapy sessions. A report, published in international journals, refers to a large meta-analysis of data from 52.000 patients, shows that treatment of prostate cancer with interstitial brachytherapy has at least the same success rates as the other two approaches. At the same time, however, the extra advantage of (IB) is that it has very low side-effect percentages (<1% urinary incontinence, <5% serious, i.e.: Grade 3-4, more severe side-effects from the gastrointestinal and urinary system, and >75% in maintaining erectile function), plus the fact that this treatment can be completed within 1 or 2 sessions, each of which in total, including post-operation monitoring in the ward of normally a couple of days.

Breast Cancer

To patients with breast cancer, radiotherapy treatment after surgical removal of the tumor increases survival chances, and is an integral part of the therapy throughout each stage of the disease. To patients with low risk cancer, the partial breast radiation treatment with interstitial brachytherapy (IB), offers an alternative and very effective approach, again with very encouraging results. In comparison to external radiotherapy, IB has the advantage that it is carried out in twice a day for a period of 5 to 7 days, and that radiation is concentrated in the bed of the tumor, significantly reducing the dose from infiltrating the skin, heart and lungs.

Cervical Cancer

Brachytherapy is an integral part of cervical cancer radiotherapy. Studies have shown that incorporating brachytherapy into the treatment regimen (plan?) increases survival rates by 20-40%. In the brachytherapy of the cervix performed at the GOC, intraocular catheters are placed, not only in the area of ​​the cervix but also in the area of ​​the umbilical cords where the tumour may expand and is not covered by the “classic” intravaginal brachytherapy procedure. Magnetic Resonance Imaging (MRI) is used to design the brachytherapy plan, which helps to determine the tumour more accurately, and also to asses the degree of response to previous radiotherapy. With modern, image-guided brachytherapy, local control rates range from 85-100% depending on the stage of the disease, while the rate of serious side effects from the gastrointestinal tract is less than 5%.

Palliative Care

Palliative radiotherapy is mainly recommended for locally advanced cancers and individual metastases in order to treat symptoms such as pain, bleeding, ulcers, shortness of breath, etc. The aim is to improve the quality of life of patients and delay the progression of the disease. In this context, brachytherapy, due to the possibility of administering high doses within the tumour, has the advantages of the rapid onset of the therapeutic effect and the small range of side effects. Brachytherapy in palliative care can be used for most solid tumours and is given in one or just a few sessions depending on the extent, location and histology of the disease.

Indicatively, brachytherapy is used successfully in recurrences of brain tumours, head-neck tumours, primary and secondary lung and liver tumours, soft tissue sarcomas, bladder tumours, prostate tumour recurrence and bone metastases with bone metastases.

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