The Virginia Commonwealth University technique of interstitial brachytherapy

Abstract

Although the newer techniques of MammoSite RTS and 3D conformal radiation therapy are now established and promise to simplify APBI, these techniques have not yet been shown to be as universal as the multicatheter approach. The multicatheter technique continues to be the most adaptable and universally applicable approach, and can be applied regardless of breast size or lumpectomy cavity size, shape or location. At VCU, a CT-guided placement technique for multicatheter brachytherapy was developed. This technique assures target coverage and improves procedural efficiency. This technique is discussed in detail in this chapter. In outline form, the procedure consists of a preprocedure evaluation, patient preparation, stainless steel trocar placement with intermittent CT guidance, flexible catheter exchange, final CT acquisition, and CT-based 3D treatment planning. The clinical outcomes of this approach are also reported. The CT-guided catheter placement technique is a reliable method of implant construction that results in reproducible target coverage and dose homogeneity, which promises to translate into improved disease control and reduced toxicity. © 2009 Springer Berlin Heidelberg.