Permanent and high dose rate brachytherapy (technique, indications, results, morbidity)

Abstract

Radiation dose escalation improves prostate cancer outcomes and brachytherapy provides direct radiation dose escalation into the gland whilst minimizing dose to adjacent rectum and bladder. Two types of brachytherapy are commonly used: low dose rate (LDR), involving permanent implantation of radioactive seeds; and high dose rate (HDR), where the dose is delivered from a single radioactive source that moves through temporary implanted catheters. Current studies suggest that brachytherapy, either alone for low risk disease, or combined with external beam radiotherapy, for higher risk disease, results in improved prostate cancer control rates when compared to external beam radiotherapy alone. Improvements in brachytherapy technology have refined dose delivery with the more widespread introduction of HDR after loading devices, more sophisticated computerized treatment planning systems and the incorporation of 3D imaging into the planning process. This chapter provides an overview of the techniques, indications and clinical outcomes for both LDR and HDR prostate brachytherapy.