PDR brachytherapy: a report on one – year clinical experience at the Medical University of Gdańsk

Abstract

Purpose

One-year clinical experience with pulse dose rate (PDR) brachytherapy is presented.

Material and methods

Between March 1999 and June 2000 intracavitary, intraluminal, and interstitial PDR brachytherapy was performed in 119 patients with a variety of malignancies. The dose per pulse of 0.5–4 Gy, repeated each hour, or 6 Gy per application was administered, up to the total dose of 6–70 Gy, using a microSelectron-PDR remote afterloading system with a ¹⁹²Ir source of 1 Ci nominal activity. The planning system PLATO BPS (version 13) was used for dose calculations. Depending on individual applications, the algorithms of the dose point, the geometrical volume, or the geometrical point dose distribution optimization in PDR treatment planning were performed. In 40 patients therapy was given with a curative intent, and 74 cases were treated palliatively. In the remaining five patients PDR was applied as salvage therapy in the previously irradiated area.

Results

With a median follow-up of 11 months (range 1–18 months) local control was maintained until the last follow-up or death in 39 out of 40 patients treated with radical intent. The subjective improvement was achieved in more than a half of patients with advanced esophageal and lung carcinomas presenting dysphagia and dyspnoe. Significant acute toxicity (severe esophagitis precluding subsequent POR application) occurred in only one patient. Delayed vaginal cuff necrosis was observed in one woman who received prior pelvic irradiation for gynaecological cancer.

Conclusion

The PDR brachytherapy is a safe and clinically effective method in a variety of malignancies. The possibility of programme optimization combined with the use of relatively wide range of pulse doses makes it possible to deliver an optimal brachytherapy scheme.