Brachytherapy: criteria for case selection

Brachytherapy has an established role in the management of a number of malignancies. Contributing to successful application of brachytherapy techniques are proper planning, technical sophistication, and meticulous execution. Equally important, presumably, is proper case selection although conditions favoring brachytherapy utilization are not well described. To facilitate discussion of this topic, a semiquantitative system of brachytherapy case selection is proposed. Variables considered include the natural history of the malignancy, risks involved in the procedure, accessibility of implant site, and results obtainable with other treatment modalities. Brachytherapy Case Selection Scores (0-8) were generated for a number of malignancies. Higher scores were found for sites in which the use of brachytherapy is generally accepted and practiced, implying that the clinical factors considered in this system are clinically relevant, and that such a system could be useful when considering the use of brachytherapy in individual cases. Additional critical analysis regarding brachytherapy case selection is desirable.