Brachytherapy: Applications and Techniques PDF
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Brachytherapy Applications and Techniques Brachytherapy Applications and Techniques EDITOR PHILLIP M. DEVLIN, MD Chief,DivisionofBrachytherapy Dana-FarberCancerInstitute BrighamandWomen’sHospital AssistantProfessorofRadiationOncology HarvardMedicalSchool Boston,Massachusetts AcquisitionsEditor:JonathanW.Pine,Jr. ManagingEditor:AnneE.Jacobs ProjectManager:AliciaJackson SeniorManufacturingManager:BenjaminRivera AssociateDirectorofMarketing:AdamGlazer CreativeDirector:DougSmock CoverDesigner:ShawnGirsberger ProductionServices:LaserwordsPrivateLimited,Chennai,India Printer:WalsworthPublishingCo. ©2007byLIPPINCOTTWILLIAMS&WILKINS,aWoltersKluwerbusiness 530WalnutStreet Philadelphia,PA19106USA LWW.com Allrightsreserved.Thisbookisprotectedbycopyright.Nopartofthisbookmaybereproducedinany formorbyanymeans,includingphotocopying,orutilizedbyanyinformationstorageandretrieval systemwithoutwrittenpermissionfromthecopyrightowner,exceptforbriefquotationsembodied incriticalarticlesandreviews.Materialsappearinginthisbookpreparedbyindividualsaspartof theirofficialdutiesasU.S.governmentemployeesarenotcoveredbytheabove-mentionedcopyright. PrintedintheUSA LibraryofCongressCataloging-in-PublicationData Brachytherapy:applicationsandtechniques/editor,PhillipM.Devlin. p.;cm. Includesbibliographicalreferencesandindex. ISBN13:978-0-7817-6277-9 ISBN10:0-7817-6277-4 1.Radioisotopebrachytherapy. I.Devlin,PhillipM. [DNLM:1.Brachytherapy.WN250.5.B7B7962007] RC271.R27B73442007 615.8(cid:1)424—dc22 2006028868 Carehasbeentakentoconfirmtheaccuracyoftheinformationpresentedandtodescribe generallyacceptedpractices.However,theauthors,editors,andpublisherarenotresponsiblefor errorsoromissionsorforanyconsequencesfromapplicationoftheinformationinthisbookand makenowarranty,expressedorimplied,withrespecttothecurrency,completeness,oraccuracyof thecontentsofthepublication.Applicationofthisinformationinaparticularsituationremainsthe professionalresponsibilityofthepractitioner. 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VisitLippincottWilliams&WilkinsontheInternet:atLWW.com.LippincottWilliams&Wilkins customerservicerepresentativesareavailablefrom8:30amto6pm,EST. 10 9 8 7 6 5 4 3 2 1 IN MEMORIAM PATRICK CHRISTOPHER DEVLIN 1996–2005 Contributors List MICHELE ALBERT, MD Instructor in Radiation PETER HAN, MD Coordinator, Division of Oncology, Department of Radiation Oncology, Brachytherapy, Department of Radiation Oncol- Harvard Medical School; Instructor in Radia- ogy, Beth Israel Medical Center, New York, tion Oncology, Department of Radiation Oncol- NewYork ogy, Dana-Farber Cancer Institute, Brigham and JORGEN L. HANSEN, MS Instructor, Department Women’sHospital,Boston,Massachusetts of Radiation Oncology, Harvard Medical School; Medical Physicist, Department of Radiation On- DOUGLAS W. ARTHUR, MD Associate Professor, cology, Brigham and Women’s Hospital, Boston, Radiation Oncology Department and Vice Chair- Massachusetts man,DepartmentofRadiationOncology,Virginia Commonwealth University Medical Center, Rich- LOUISB.HARRISON,MD Professor,RadiationOn- mond,Virginia cology,AlbertEinsteinCollegeofMedicine,Bronx, New York; Chairman, Radiation Oncology, Beth ARNAB CHAKRAVARTI, MD Associate Professor, IsraelMedicalCenterandSt.Luke’sRooseveltHos- DepartmentofRadiationOncology,HarvardMed- pitalCenter,NewYork,NewYork ical School; Associate Radiation Oncologist, De- CAROLINE L. HOLLOWAY, MD, FRCP(C) Clini- partment of Radiation Oncology, Massachusetts cal Instructor, Faculty of Medicine, University of GeneralHospital,Boston,Massachusetts British Columbia, Vancouver, British Columbia; ROBERT A. CORMACK, PhD Assistant Professor, Radiation Oncologist, Department of Radiation DepartmentofRadiationOncology,HarvardMed- Oncology, BC Cancer Agency—Cancer Centre for ical School; Director of Brachytherapy Physics, theSouthernInterior,Kelowna,BritishColumbia, Department of Radiation Oncology, Dana-Farber Canada CancerInstitute,BrighamandWomen’sHospital, KENNETH S. HU, MD Assistant Professor, Depart- Boston,Massachusetts ment of RadiationOncology,AlbertEinsteinCol- lege of Medicine, Bronx, New York; Attending LAURIE W. CUTTINO, MD Assistant Professor,De- Physician, Department of Radiation Oncology, partment of Radiation Oncology, Virginia Com- BethIsraelMedicalCenter,NewYork,NewYork monwealthUniversity,Richmond,Virginia JAMES E. HUGH III, MHA Senior Vice President, BRIAN G. CZITO, MD Assistant Professor, Depart- AmericanMedicalAccountingandConsulting,Inc, ment of Radiation Oncology, Duke University, Marietta,Georgia Durham,NorthCarolina BLEDDYNJONES,MA,MSc,MB,BChir,MD,FRCP, THOMAS F. DELANEY, MD Associate Professor, FRCR, MedFIPEM Hon. Professor, The Univer- sity of Birmingham Medical School, The Uni- DepartmentofRadiationOncology,HarvardMed- versity of Birmingham, Edgbaston, Birmingham; icalSchool,Boston,Massachusetts;MedicalDirec- Consultant in Clinical Oncology and Applied Ra- tor,DepartmentofRadiationOncology,FrancisH. diobiology, Birmingham Cancer Centre, Univer- BurrProtonTherapyCenter,MassachusettsGeneral sity Hospital Birmingham, Birmingham, United Hospital,Boston,Massachusetts Kingdom PHILLIP M. DEVLIN, MD Chief, Division of JOSEPH R. KELLEY, MD, PhD Chief Resident, De- Brachytherapy, Dana-Farber Cancer Institute, partment of Radiation Oncology, Virginia Com- Brigham and Women’s Hospital; Assistant Pro- monwealthUniversityMedicalCenter,Richmond, fessor of Radiation Oncology, Harvard Medical Virginia School,Boston,Massachusetts MATTHEW J. KRASIN, MD AssociateMember,Di- HUAN GIAP, MD, PhD (Corresponding Author) vision of Radiation Oncology, Department of Ra- DepartmentofRadiationOncology,ScrippsClinic, diological Sciences, St. Jude Children’s Research LaJolla,California Hospital,Memphis,Tennessee viii ContributorsList LINDA L. LIVELY, MHA President, American Med- NASIR H. SIDDIQI, MD Instructor in Radiology, ical Accounting and Consulting. Inc, Mari- Harvard Medical School; Attending Radiologist, etta,Georgia Department of Radiology, Brigham and Women’s Hospital,Boston,Massachusetts JAYS.LOEFFLER,MD HermanandJoanSuitPro- ALEXANDRAJ.STEWART,BM,MRCP,FRCR Spe- fessor,HarvardMedicalSchool;Chair,Department cialistRegistrar,DepartmentofClinicalOncology, of Radiation Oncology, Massachusetts General RoyalMarsdenHospital,Sutton,UnitedKingdom Hospital,Boston,Massachusetts DAVID J. SUGARBAKER, MD The Richard E. Wil- HARVEY J. MAMON, MD, PhD Assistant Profes- son Professor of Surgical Oncology, Department sor, Department of Radiation Oncology, Harvard of Radiation Oncology, Harvard Medical School; Medical School; Clinical Director, Department of Chief, Division of Thoracic Surgery, Phillip E. Radiation Oncology, Dana-Farber Cancer Insti- Lowe Senior Surgeon, Dana-Farber Cancer Insti- tute, Brigham and Women’s Hospital, Boston, tute, Brigham and Women’s Hospital, Boston, Massachusetts Massachusetts ANDRE´-GUYMARTIN,MD,MSc,FRCP(C) Affiliate W. WARREN, SUH, MD, MPH Instructor, Depart- Clinical Professor, Department of Radiation On- mentofRadiationOncology,Dana-FarberCancer cology,CentreHospitalierUniversitairedeQuebec, Institute,BrighamandWomen’sHospital,Boston, L’Hotel-Dieu de Quebec; Radiation Oncologist & Massachusetts Brachytherapist, Department of Radiation Oncol- PRABHAKAR TRIPURANENI, MD, FACR Division ogy, Centre Hospitalier Universitaire de Quebec, Head,DepartmentofRadiationOncology,Scripps L’Hotel-DieudeQuebec,Quebec,Canada Clinic,LaJolla,California THOMAS E. MERCHANT, DO, PhD Chief, Divi- FRANK A. VICINI, MD, FACR Clinical Associate sion of Radiation Oncology, St. Jude Children’s Professor, Department of Radiation Oncology, ResearchHospital,Memphis,Tennessee University of Michigan, Ann Arbor, Michigan; ChiefofOncology,OncologyServicesAdministra- SUBHAKAR MUTYALA, MD Assistant Professor, tion,DepartmentofRadiationOncology,William DepartmentofRadiationOncology,AlbertEinstein BeaumontHospital,RoyalOak,Michigan College of Medicine; Director of Brachytherapy, AKILA N. VISWANATHAN, MD, MPH Assistant Department of Radiation Oncology, Montefiore Professor of Radiation Oncology, Department of MedicalCenter,Bronx,NewYork,NewYork Radiation Oncology, Harvard Medical School; DESMOND A. O’FARRELL, CMD Senior Dosi- Chief, Division of Gynecologic Radiation Oncol- metrist, Department of Radiation Oncology, ogy, Department of Radiation Oncology, Dana- Dana-Farber Cancer Institute, Brigham and Farber Cancer Institute, Brigham and Women’s Women’sHospital,Boston,Massachusetts Hospital,Boston,Massachusetts GERARDWALSH,MBA TeachingAssociate,Depart- DANIELG.PETEREIT,MD AssociateProfessor,Uni- ment of Radiation Oncology, Harvard Medical versity of South Dakota Medical School, South School; Director of Radiation Oncology, Depart- Dakota; Assistant Professor, Department of Hu- ment of Radiation Oncology, Children’s Hospi- man Oncology, University of Wisconsin Medical tal, Dana-Farber Cancer Institute, Brigham and School, University of Wisconsin School of Public Women’s Hospital, Brigham and Women’s Physi- Health and Medical School, Madison, Wisconsin; cianOrganization,Boston,Massachusetts Radiationoncologist,DepartmentofRadiationon- cology,RapidCity RegionalCancer Center, Rapid CHRISTOPHER G. WILLETT, MD Leonard R. Pros- City,SouthDakota nitz Professor and Chair, Radiation Oncology, Duke University Medical School; Radiation On- CHANDRAJIT P. RAUT, MD, MSc Instructor of cologist, Department of Radiation Oncology, Surgery, Department of Surgery, Harvard Med- Duke University Medical Center, Durham, North ical School; Associate Surgeon, Department of Carolina Surgery, Brigham and Women’s Hospital, Boston, JENNIFER S. WILSON, BA Coordinator, Division Massachusetts of Brachytherapy, Department of Radiation On- RAVI A. SHANKAR, MD Assistant Professor, Divi- cology, Dana-Farber Cancer Institute, Brigham sionofRadiationOncology,H.LeeMoffittCancer and Women’s Hospital, Harvard Medical School, Center&ResearchInstitute,Tampa,Florida Boston,Massachusetts Foreword I am pleased to write this Foreword to the first edition of Brachytherapy: Applications and Techniques, edited by Dr. Phillip Devlin. Brachytherapyhas a long history and has served an important role in radiation therapy, which continues to this day. One can reasonably claim that brachytherapy has led the way in conformal and image-guided treatment for externalbeamradiationtherapy.Brachytherapyisimportantinthemanagementofawide range of malignancies, including (but not limited to) gynecologic malignancies, prostate cancer, various head and neck tumors, sarcomas, breast cancer, and palliation. At our institution,brachytherapyisalargeandgrowingpartofourcareandiscentralizedunder Dr.Devlin’sleadership.Wehavefoundthatthecentralizationofbrachytherapyhasresulted in improved treatments resulting from specialization, ‘cross fertilization’ across different disease sites, and continuouslyimproving qualityassurance. The results of brachytherapy are highly technique-dependent, arguably more akin to surgery than to external beam radiationtherapy. The field of brachytherapy is a large one, but is often relegated to a small chapter in standard radiation oncology textbooks. Moreover, the field has shown considerable evolution in image guidance, techniques, and dosimetry. The use of high-dose rate approaches instead of traditional low-dose rate approaches is but one example. Given thelargescopeofthefieldanditsconsiderablenewinformation,thisbookisatimelyand neededcontribution. Thebookprovidesacomprehensive,up-to-date,anddetailedsingle-sourcecompilation of the importantknowledgeon the use of brachytherapyin the variousdisease sites. It is presentedinaformaccessibletopracticingcliniciansand,giventhetechnicalrequirements ofbrachytherapy;thereisparticularemphasisonthepracticalaspectsofitsuse.Dr.Devlin hasbroughttogetheradiverseanddistinguishedgroupofexpertsforthiseffort.Ofspecial notearethetwointroductorychaptersontheimportantradiobiologicandphysicsprinciples thatunderlietheuseofbrachytherapyandafinalchapteronthebusinessaspectsofitsuse. Here,too,theauthorsprovidepracticaladviceforthepracticingclinician. Dr.DevlinhasdevelopedourbrachytherapyserviceatBrighamandWomen’sHospital and Dana-Farber Cancer Institute simultaneously stressing clinical care, training, and research.Thisbookclearlymanifestshisvisionforanddedicationtothefield.Icouldnot bemorepleasedorproudtohavethisoccuratourinstitution. JayR.Harris ProfessorandChair DepartmentofRadiationOncology Dana-FarberCancerInstitute BrighamandWomen’sHospital HarvardMedicalSchool
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