Fractionated perioperative high dose rate brachytherapy using a tissue equivalent bendy applicator

Area of Science:

• Oncology
• Radiation Oncology
• Medical Physics

Background:

• Intraoperative radiation therapy (IORT) delivers a local dose to high-risk areas, potentially reducing local failure.
• Perioperative brachytherapy allows for fractionated radiation delivery, offering a potential alternative to single-dose IORT.
• Fractionation may improve the therapeutic ratio and protect late-reacting tissues.

Purpose of the Study:

• To introduce a novel tissue equivalent bendy applicator (TEBA) for prolonged in situ use.
• To examine the feasibility of fractionated perioperative high dose rate (HDR) brachytherapy using the TEBA.
• To evaluate the potential benefits of fractionated perioperative brachytherapy over single-dose IORT.

Main Methods:

• A prospective study involving 31 patients with diverse tumors (soft tissue sarcoma, Ewing's sarcoma, rectal cancer, locally infiltrating diseases).
• Application of the TEBA based on resection status and intraoperative findings.
• Treatment planning using digitized radiographs and CT scans, followed by individualized fractionated perioperative HDR brachytherapy schedules.

Main Results:

• Perioperative radiation was administered to 29 patients, with fractionated brachytherapy successfully applied in 26 cases.
• TEBA dwell times ranged from 1 to 11 days, delivering 1 to 8 fractions with total doses of 10 Gy to 25 Gy.
• Fractionated perioperative brachytherapy using the TEBA technique was found to be feasible and adequate.

Conclusions:

• Fractionated perioperative HDR brachytherapy utilizing the TEBA is a feasible and adequate treatment modality.
• Further research is needed to confirm if the TEBA technique offers superior outcomes, including reduced late toxicity and improved local tumor control, compared to single-dose IORT.