Interventional Radiation Therapy: Techniques — Brachytherapy

376 Pages·1991·12.684 MB·English

by  Roger A. Potish M.D., Seymour H. Levitt M.D. (auth.), Professor Dr. Rolf Sauer (eds.)

MEDICAL RADIOLOGY
Diagnostic Imaging and Radiation Oncology
Editorial Board
L. W. Brady, Philadelphia . M. W. Donner, Baltimore
H.-P. Heilmann, Hamburg· F. Heuck, Stuttgart
Interventional
Radiation Therapy
Techniques - Brachytherapy
Contributors
G.Alth· H.Annweiler· H. W.Anton· J.M.Ardiet· J.J.Augsburger· K.Baier
F. Baillet . H. Bartelink . J. H. Borger· A. M. Borofsky . L. W. Brady· M. Busch
H.Busse· D.Chassagne· J.L.Chassard· e.T.Coughlin· J.L.Day· J.Dunst
B.Emami· REngenhart· H.Ernst· W.A.Fair· R.Fietkau· Z.Fuks· F. P. Gall
J.P.Gerard· B.J.Gerbi· F. H. Glaser . G.Grabenbauer· L.Grimard· J.Hammer
H.-P.Heilmann· B.S.Hilaris· H.Ikeda· T.Inoue· H.Junkermann· V.L.Karlsson
B.N.Kimmig· K.-H.Kloetzer· D.Kob· e.Koprowski· T.Kozuka· J.e.Kummermehr
K.Kuphal· e.K.Lee· S.H.Levitt· D.A.Lightfo~t· P.K.Lommatzsch· K.Lutz
H.-B.Makoski· G.Marinello· A.M.Markoe· N.Masaki· R.E.Maxwell· J.J.Mazeron
J.F.Montbarbon . e.R.Moorthy· RG.Miiller· R-P.Miiller· F.Mundinger
D.Nori· e.G.Orton· e. B. Ostertag . S.Ozeki· J.Papillon· e.A.Perez· B.Pierquin
G.Pipard· R.A.Potish· R.Potter· M.Riccabona· K.Rotte· R.Sauer· P.Schlag
G.Schlegel· M.H.Seegenschmiedt· J.A.Shields· J.Slanina· H.Sommerkamp
A. Sparenberg . W. Spitzer· V. Sturm· A. E. Tchelebi . N. Thesen
A.J.S.Tjokrowardojo· P.Touraine-Romestaing· K.-R.Trott· p.e.Veraguth
A.G. Visser· D.von Fournier· M. Wannenmacher· M. Weidenbecher· K. Weigel
W. F. Whitmore· F. Wilson· G. Wolf· N. Wolf· R. Woodleigh
Edited by
Rolf Sauer
Foreword by
Luther W. Brady and Hans-Peter Heilmann
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Hong Kong Barcelona
Professor Dr. ROLF SAUER
Strahlentherapeut ische U niversitatsklinik
der Universitat Erlangen-Niirnberg
U niversitatsstr. 27
8520 Erlangen, Germany
MEDICAL RADIOLOGY· Diagnostic Imaging and Radiation Oncology
Continuation of
Handbuch der medizinischen Radiologie
Encyclopedia of Medical Radiology
With 193 Figures
ISBN-13:978-3-642-84165-1 e-ISBN-13:978-3-642-84163-7
DOl: 10.1007/978-3-642-84163-7
Library of Congress Cataloging-in-Publication Data. Interventional radiation therapy techniques - brachytherapy /
contributors, G. Alth ... let al.]; edited by Rolf Sauer; foreword by Luther W. Brady and H.-P. Heilmann. p. em
(Medical radiology) Includes bibliographical references. Includes index.
ISBN-I3:978-3-642-84165-1
1. Radioisotope brachytherapy. 2. Cancer-Interventional radiology. I. Alth, Gerhart. II. Sauer, Rolf. III. Series.
[DNLM: 1. Brachytherapy. 2. Neoplasms-radiotherapy. QZ 269 1628] RC271.R27164 1991 616.99'406424-dc20
DNLMIDLC
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Foreword
Brachytherapy is examined at length and in depth in this book, edited by ROLF
SAUER, professor at the University of Erlangen. This treatment is basically the
therapeutic utilization of encapsulated radionuclides placed close to or within a
tumor. The entire technique involves either the insertion of molds or moulages in the
proximity of a tumor or the interstitial application of radionuclide sources.
From a historical point of view, the first utilization of brachytherapy in treatment
was in 1901, three years after the discovery of radium by Marie Sklodowska Curie.
The episode was initiated when Pierre Curie gave a small amount of radium in a tube
to Dr. HENRI DAN LOS, suggesting that it be inserted within a tumor. Some two years
later Dr. ALEXANDER BELL made the same suggestion in a letter to the editor of the
Archives of Roentgen Ray.
Progress in the application of brachytherapy was rapid thereafter, and improve
ments in the technique allowed many different types of tumors to be treated by
brachytherapy programs. Radon was used in the form of tiny glass tubes inserted
within the tumor as a permanent implantation. Reports from various investigators
demonstrating the usefulness of the technique began to appear in the literature.
In the early 1920s, CLAUDIUS REGAUD concluded that certain types of cancer could
successfully be treated by radium needles of low intensity applied for periods of 6-10
days. Regaud's technique met with excellent results in intraoral cancer and was
widely accepted.
In the 1930s, PATfERSON and PARKER developed a system of rules for the utiliza
tion of radionuclide sources allowing for uniform distribution of the radiation dose
within the implanted region. Although complex, they became popular and widely
accepted. At about the same time, EDITH QUIMBY developed a set of rules and tables
for "the unsophisticated" radiotherapist who was deterred from using the Patterson
and Parker system. This system provided for the designation of an average dose
within the volume implanted. The sources were uniformly spaced but the best
delivery was inhomogeneous in character.
In the late 1950s, various radium substitutes became available including iodine-
125, iridium-19 2, and cesium-135, as well as other radionuclides. The widespread use
of these radionuclides in various techniques are fully explored in depth and in a most
scientific fashion by the contributors to this volume. This book represents an
important and significant update on the utilization of this treatment technique in
cancer.
From the data presented by the contributors to this volume, it is obvious that
brachytherapy will continue to playa crucial role in the treatment of cancer. With
afterloading devices, the more precise dosimetry for treatment programs as well as
the innovations in the methods of application will contribute immeasurably to
improving the potential for cure in cancer patients and at the same time minimizing
the complications resulting from the treatment program.
LUTHER W. BRADY, M.D.
HANS-PETER HEILMANN, M.D.
Preface
Interventional radiotherapy embraces various techniques of operative radiation
therapy: interstitial and intracavitary brachytherapy, interstitial hyperthermia and
intraoperative radiation therapy. In this field, the radiation oncologist cooperates
with specialists from several other fields such as neurosurgery, ophthalmology, ENT,
surgical oncology, gynecology, urology, medical physics and basic sciences. In this
context, the interdisciplinary character of radiation oncology proves particularly
valuable in forging links between the various oncological disciplines. The radio
therapist is required to have a knowledge of surgical technique and an understanding
of the special anatomy in the field concerned, in addition to manual dexterity, and the
surgeon must acquire a knowledge of radiobiology, radiophysics and radiation
protection. The activity of both is based on the latest developments in radiophysics
and advances in radiobiology.
In this volume we limit ourselves to brachytherapy. Intracavitary or interstitial
radiotherapy offers the considerable advantage of delivering a high dose to a limited
target volume within a short time without subjecting the surrounding healthy tissue to
excessive exposure. Advanced radiobiological perceptions permit the use of the most
favorable dose rate.
As early as 1901 PIERRE CURIE made a small amount of radium available to Dr.
HENRI ALEXANDRE DANLOS, a dermatologist at the H6pital St. Louis, Paris, who
used it in several surface applicators for the treatment of skin lesions. This was the
beginning of brachytherapy - the treatment of lesions with radionuclides at short
distance, in contrast to percutaneous teletherapy. Since that time, brachytherapy has
developed by leaps and bounds.
In 1905 ROBERT ABBE, of St Lukes Hospital, New York, introduced for the treat
ment of skin tumors radium capsules which were placed in celluloid tubes implanted
previously. This was the first afterloading treatment. In the same year, FRICKE, in
Manchester, developed the first gynecological applicators. In 1925 FAILLA, of
Memorial Hospital, New York, discovered that ~-rays, which were responsible for
tissue necroses, could be filtered by encapsulating radium and radon in attenuating
material such as gold. HEYMAN and others at Radiumhemmet, Stockholm, treated
patients suffering from cervical cancer by using three equal applications of 20 to 24 h
in duration with intervals of 1-3 weeks between applications. At the Institute Curie,
Paris, C. REGAUD observed that low-intensity radium applied over several days was
more effective than higher-intensity radium tubes and shorter treatment periods. In
Manchester, PATERSON and PARKER developed an interstitial dosimetric system for
radium sources with different linear activity, the so-called Manchester system.
In 1934, JOLIOT-CURIE, Paris, discovered continued artificial radioactivity. In 1953
ULRICH HENSCHKE, in New York, carried out the first interstitial implants, employing
postoperative afterloading techniques. He then systematically carried on the
development of afterloading therapy: in 1955 he replaced radium-226 with iridium-
192 wires, and in 1960 he developed an afterloading technique for intracavitary
irradiation of gynecological malignancies. In 1965 the first iodine-125 seeds were
applied in New York in HENSCHKE and HILARIS.
VIII Preface
In the 1960s and 1970s, the increasing use of cobalt-60 teletherapy units and linear
accelerators with electron beam capabilities caused the popularity of brachytherapy
to decline. Physicians also began to suffer the consequences of excessive radiation
exposure resulting from the improper handling of hazdardous radioactive material.
In the last decade, however, brachytherapy experienced a dramatic revival in
conjunction with other new modalities such as hyperthermia and chemotherapy.
The introduction of new radioisotopes with favorable nuclear physical properties,
computer-assisted dosimetry and in particular the advent of modified afterloading
techniques set off this revolutionary development. Afterloading techniques especially
permit increased flexibility of implant design and reduction or even complete
elimination of radiation exposure for surgeons and nursing staff. This resulted in
more accurate placement of radioactive sources and more convenient and better care
of the patient.
Interstitial therapy alone is instituted for palliative and curative purposes in the
case of brain tumors, tumors of the head and neck, skin tumors, prostate carcinoma
and gynecological malignancies. However, curative treatment is only possible with
well-defined and well-differentiated tumors, e.g. TI-2 GI-2 prostate carcinomas, or
with Tl NO MO tumors of the oral cavity. It constitutes the exception rather than the
rule. In the event of recurrences or lesions not responsive to other treatment
modalities, brachytherapy alone may still frequently produce a palliative effect.
As a rule, brachytherapy is employed in conjunction with external beam irradiation
for boosting purposes. The radiobiological rationale indicates that a higher dose is
required with increasing tumor size to bring the malignancy under control. The main
tumor mass is treated interstitially with a booster dose, the subclinical peripheral
portions of the primary tumor and the lymphatic drainage area are irradiated per
cutaneously. This procedure is mainly employed in the head and neck and with breast
cancer, anal canal carcinoma and gynecological malignomas.
It makes sense to combine interstitial brachytherapy with interstitial hyperthermia,
because the in-dwelling tubes for brachytherapy can also used for antennae and
thermocouples. The given geometric arrangement of the applicators permits a
uniform temperature distribution which is better than that achieved with external
hyperthermia.
The idea of preparing the present volume was conceived with the help of LUTHER
W. BRADY on the occasion of the international symposium on "Interventional Radio
therapy" held in autumn 1987 at Rothenburg ob der Tauber, FRG. We decided to
restrict the range of topics to the most common indications, such as brain tumors,
choroidal melanomas, head and neck tumors, mammary carcinomas, carcinomas of
the anal canal, prostate carcinoma and gynecological malignomas.
The most prominent authors from Europe and overseas have supplied con
tributions on the most frequent and attractive applications of brachytherapy. They
discuss indications and techniques and describe their personal experience. Our aim in
publishing this book is to promote scientific exchange between the countries of the
so-called Old World and our friends and colleagues in the United States and else
where. At the same time we wish to stimulate the diffusion of brachytherapy in
Germany.
ROLF SAUER
Contents
I Basic Principles
1.1 Principles of Combining External Beam and Brachytherapy
ROGER A. POTISH and SEYMOUR H. LEVUT. (With 2 Figures) 3
1.2 Fundamentals in Radiobiology
JOHANN C. KUMMERMEHR and KLAUS-RuDIGER TRorr. (With 13 Figures) 7
1.3 Fundamentals in Physics
GINE'ITE MARINELLO. (With 2 Figures) 25
1.4 Brachytherapy Techniques
REINHOLD G.MULLER. (With 6 Figures) 35
1.5 High and Low Dose Rate Remote Afterloading: A Critical Comparison
COLIN G. ORTON. (With 1 Figure) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Special Considerations
2 Brain Tumors
2.1 Basic Principles of Brachycurietherapy of Brain Tumors
SEYMOUR H.LEVITf, BRUCEJ.GERBI, CHUNG K.LEE,
and ROBERT E. MAXWELL ................................. 61
2.2 Imaging-Stereotaxic Implantation of RadionucIides in Intracranial Tumors
(Curietherapy and Brachycurietherapy)
FRITZ MUNDINGER ...................................... 67
2.3 Experimental Dose Effects After Permanent and Temporary Interstitial
Irradiation of the Brain
CHRISTOPH B.OSTERTAG. (With 3 Figures) ...................... 81
2.4 Fractionated Afterloading Therapy in the Treatment of Malignant,
Inoperable Brain Tumors
ANNE SPARENBERG, KLAUS WEIGEL, and HELMUT ERNST. (With 3 Figs.) 85
2.5 External Stereotactic Focal Irradiation
BERNHARD N. KIMMIG, VOLKER STURM, and RITA ENGEN HART
(With 5 Figures) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
2.6 External Stereotactic Focal Irradiation of Arteriovenous Malformations
by a Routinely Used Linear Accelerator
HANS-BRUNO MAKOSKI ................................... 95
X Contents
3 Choroidal Melanoma
3.1 Results After Brachytherapy Using 106Ru/H16Rh Plaques
for Choroidal Melanomas
P. K. LOMMATZSCH. (With 6 Figures) .......................... 103
3.2 Choroidal Melanoma: Role of Brachytherapy in Management
LUTHER W.BRADY, JERRY A.SHIELDS, JAMES J.AUGSBURGER, JOHN L.DAY,
REGINALD WOODLEIGH, ARNOLD M.MARKOE, and ULF L.KARLSSON
(With 6 Figures) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 113
3.3 Experience with High-Dose p-Irradiation (H16Ru/106Rh)
of Choroidal Melanomas
ROLF-P.MuLLER, R.poTfER, and H.BussE. (With 3 Figures) 123
4 Head and Neck Tumors
4.1 Classification of Oral Cavity and Oropharynx Carcinomas
ROLF SAUER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 131
4.2 Interstitial Radiotherapy of Oral Cavity and Oropharynx Carcinomas
(Paris Technique)
BERNARD PIERQUIN, JEAN JACQUES MAZERON, and LAVAL GRIMARD
(With 10 Figures) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 133
4.3 Interstitial Brachytherapy in Head and Neck Tumors
BASIL S. HILARIS, ANCA E. TCHELEBI, and CHITfI R. MOORTHY
(With 2 Figures) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 145
4.4 Manual Afterloading in Brachytherapy
(Endocurietherapy with 192Ir Wires and Needles)
PETER C. VERAGUTH. (With 7 Figures) . . . . . . . . . . . . . . . . . . . . . . . .. 153
4.5 Temporary and Permanent Brachytherapy in Advanced Head and Neck
Cancer - The Erlangen Experience
RAINER FIETKAU, MANFRED WElDEN BECHER, WOLFGANG SPITZER,
and ROLF SAUER. (With 6 Figures) ........................... 159
4.6 198 Au Implantation of Carcinoma of the Mobile Tongue
JOACHIM SLANINA, KLAUS KUPHAL, and MICHAEL WANNENMACHER
(With 5 Figures) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 169
5 Breast Cancer
5.1 Brachycurietherapy in Breast Cancer
FRANc;ms BAILLET. (With 3 Figures) .......................... 179
5.2 Interstitial Boost Irradiation: Indications, Technique, Complications
BERNARD PIERQUIN, FRANK WILSON, and DANIEL CHASSAGNE
(With 3 Figures) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 187
5.3 Interstitial Boost Irradiation Technique and Dosage
KARSTEN ROTfE and KURT BAIER. (With 11 Figures) . . . . . . . . . . . . . . .. 191
5.4 Iridium-192 Afterloading for Boosting the Tumor Bed
J.H.BoRGER and H.BARTELINK. (With 2 Figures) ................. 199
Contents Xl
6 Anal Canal Cancer
6.1 Carcinomas of the Anal Canal: An Introduction
ROLF SAUER and JURGEN DUNST ............................. 207
6.2 Role of Combined Radiochemotherapy: The Lyon Experience
J. PAPILLON, J. F. MONTBARBON, J. P. GERARD, J. L. CHASSARD, J. M. ARDIET,
and P.TOURAINE-RoMESTAING. (With 1 Figure) . . . . . . . . . . . . . . . . . .. 209
6.3 Combination Therapy of Anal Canal Cancer: A Report on External
Irradiation With or Without Chemotherapy Followed by Interstitial
Iridium 192
GUDRUN PIPARD. (With 1 Figure) ............................ 215
6.4 Radiochemotherapy of Anal Canal Cancer With or Without Interstitial
Implants
JURGEN DUNST, GERHARD GRABENBAUER, NORBERT WOLF, FRANE PAUL GALL,
and ROLF SAUER. (With 4 Figures) ........................... 221
6.5 Conservative Treatment of Anal Carcinoma: The Surgeon's View
P.SCHLAG. (With 1 Figure) ................................ 229
7 Prostatic Cancer
7.1 Interstitial Irradiation in Prostatic Cancer: Report of 10-Year Results
BASIL S. HILARIS, ZVI FUKS, DATTATREYUDU NORI, WILLIAM A. FAIR,
and WILLET F. WHITMORE. (With 9 Figures) ..................... 235
7.2 Interstitial Radiotherapy: The Freiburg Experience
H. SOMMERKAMP and MICHAEL W ANNENMACHER. (With 3 Figures) 241
7.3 Cancer of the Prostate: Brachytherapy Techniques
LUTHER W. BRADY, CHRISTOPHER KOPROWSKI, ANNE MARIE BOROFSKY,
and DAVID A.LIGHTFOOT. (With 4 Figures) . . . . . . . . . . . . . . . . . . . . .. 245
7.4 Percutaneous Iodine-125 Implantation Guided by Ultrasound
JOSEF HAMMER and MARKUS RICCABONA. (With 6 Figures) . . . . . . . . . . .. 257
7.5 Transperineal 12sI Implantation Guided by Ultrasound:
Preliminary Results of 150 Cases
GERHARD SCHLEGEL and KLAUS LUTZ. (With 3 Figures) 363
8 Gynecological Malignancies
8.1 Interventional Radiation Therapy Techniques in Gynecology
HANS-PETER HEILMANN. (With 12 Figures) . . . . . . . . . . . . . . . . . . . . .. 271
8.2 Technical Aspects of Bladder Dosimetry in Intracavitary Irradiation
of Carcinoma of the Cervix
A.J.SUBANDONOTJOKROWARDOJO and A.G. VISSER. (With 6 Figures) 279
XII Contents
8.3 Intracavitary High Dose Rate Afterloading Therapy with Iridium 192:
Basic Physical Measurements, Dosimetry, and Localization
NORFRIED THESEN. (With 10 Figures) . . . . . . . . . . . . . . . . . . . . . . . . .. 285
8.4 Present Status and Perspectives of High Dose Rate Afterloading
in Gynecologic Malignancies
HEINER ANNWEILER and MANFRED BUSCH. (With 3 Figures) .......... 291
8.5 Five-to Seven-Year Results in High Dose Rate Radiation of Cancer
of the Cervix
GERHART ALTH. (With 4 Figures) ............................ 299
8.6 Prospective Clinical Trial Concerning High Dose Rate Afterloading
Therapy in Cancer of the Cervix and Endometrium
DIETER KOB and KARL-HEINZ KLOETZER. (With 2 Figures) ........... 307
8.7 Comparison Between High Dose Rate Afterloading and
Conventional Radium Therapy
KARSTEN RmTE. (With 9 Figures) . . . . . . . . . . . . . . . . . . . . . . . . . . .. 311
8.8 High Dose Rate Afterloading Compared with Conventional Brachytherapy
FELIX H.GLASER. (With 2 Figures) . . . . . . . . . . . . . . . . . . . . . . . . . .. 319
8.9 Low and High Dose Rate Afterloading in Gynecological Malignancies
D. VON FOURNIER, H. W.ANTON, H.JUNKERMANN, and G. WOLF
(With 7 Figures) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 333
9 Interstitial Hyperthermia
9.1 Techniques and Clinical Experience of Interstitial Thermoradiotherapy
M. HEINRICH SEEGENSCHMIEDT, ROLF SAUER, LUTHER W. BRADY,
and ULF L.KARLSSON. (With 1 Figure) ........................ 343
9.2 Interstitial and Intraoperative Hyperthermia
CHRISTOPHER T.COUGHLIN. (With 4 Figures) 359
9.3 Interstitial Thermoradiotherapy in the Treatment of Malignant Tumors
BAHMAN EMAMI and CARLOS A.PEREZ . . . . . . . . . . . . . . . . . . . . . . . .. 365
9.4 Experiences With Interstitial Hyperthermia as a Sole Treatment Modality
or Combined with Radiotherapy
TAKEHIRO INOUE, NORIE MASAKI, SHUZI OZEKI, HIROSHI IKEDA,
and TAKAHIRO KOZUKA. (With 2 Figures) . . . . . . . . . . . . . . . . . . . . . .. 371
Subject Index ......................................... 375
List of Contributors ..................................... 379