Modern head and neck brachytherapy: from radium towards intensity modulated interventional brachytherapy

Abstract

Intensity modulated brachytherapy (IMBT) is a modern development of classical interventional radiation therapy (brachytherapy), which allows the application of a high radiation dose sparing severe adverse events, thereby further improving the treatment outcome. Classical indications in head and neck (H&N) cancers are the face, the oral cavity, the naso- and oropharynx, the paranasal sinuses including base of skull, incomplete resections on important structures, and palliation. The application type can be curative, adjuvant or perioperative, as a boost to external beam radiation as well as without external beam radiation and with palliative intention. Due to the frequently used perioperative application method (intraoperative implantation of inactive applicators and postoperative performance of radiation), close interdisciplinary cooperation between surgical specialists (ENT-, dento-maxillary-facial-, neuro- and orbital surgeons), as well interventional radiotherapy (brachytherapy) experts are obligatory. Published results encourage the integration of IMBT into H&N therapy, thereby improving the prognosis and quality of life of patients.

Review of photon and proton radiotherapy for skull base tumours

“…109 The role of brachytherapy is mainly limited to the treatment of primary and recurrent nasopharyngeal carcinoma where it can significantly improve the therapeutic window. 110 …”

Electromagnetic tracking for treatment verification in interstitial brachytherapy

“…Interstitial brachytherapy (IBT) is a treatment option for a variety of tumor sites including, e.g., prostate [1], head and neck [2], breast [3], and gynecology [4]. Implantation of the needles/catheters (without loss of generality, all different types of needles or catheters will be referred to as catheters in this article, unless a differentiation is required) is patient specific and requires imaging such as computed tomography (CT), magnetic resonance imaging (MRI), transrectal ultrasound (TRUS), or conventional X-rays to determine the track of each implanted catheter, the so-called implant geometry.…”

Image-guided high-dose-rate brachytherapy of head and neck – a case series study

“…The possibility of repeated irradiation is also limited due to high risk of radiotherapy related morbidity. In case of brachytherapy, the relapsed lesion location creates a limitation, which in many cases prevents correct placement of brachytherapy applicators in tumor [3]. Traditionally, brachytherapy is reserved for application in surface lesions where the risk of mechanical damages and surgery related complications is small.…”