[Improvement of gynecologic radium therapy through the afterloading method using cesium 137]

For all centers performing gynecological contact irradiation the use of afterloading techniques is urgently required, since they eliminate any radiation exposure to the personnel. The radio-therapist may position and control the empty applicators still free from radiation withoug haste. This procedure diminishes the occurrence of overdosages and underdosages. The care for the patients is possible without radiation exposure, and the morbidity of contact therapy can be reduced by occasional mobilization of the patient, the applicator without sources remaining at its place. The fully automatic apparatus "Curietron" using cesium-137 sources (0.662 MeV gamma emission, half-life period 26.6 years) with an equivalent source activity (factor 2.6) yields the dose distribution demanded in the gynecologic field which in practice is identical to that of Ra-226 (medium gamma emission 1 MeV, half-life period 1620 years). With similar dose distribution, a biological and therapeutical effect alike to Ra-226 may be expected from Cs-137. In comparison with Ra-226, the following advantages of Cs-137 may be mentioned: Lower half-value thickness of 5.5 mm lead (low expenses for radioprotection), less danger with handling (no emanation of radioactive gases), and lower contamination risks in case of breaking. The measured dose distributions at equivalent source activity and similar geometry of the applicators revealed the possibility with regard of all techniques of gynecologic irradiation utilized in our field of arriving at similar relative and absolute dose distributions by means of the Cs-137 afterloading technique. Whilst short-term afterloading irradiation with highly active sources, their radiobiological effectiveness being not yet ascertained, has to be tested at appropriate scientific centers, it is necessary to demand afterloading techniques with dosages and duration of irradiations approved over decades for all centers of gynecological contact therapy because of radiation protection.