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Megan Whitley Brachytherapy April 24, 2013

Brachytherapy, derived from the Greek word short, as in a short distance, is known today as the application of radioactive materials within or in close proximity to a patient.1 The radioactive materials associated with brachytherapy are typically radium, cobalt-60, cesium-137, iodine-125, and iridium-192. There are several methods in which to deliver a dose of radiation via these radioactive sources. Some examples are needles, tubes, wires, or seeds, and for the purposes of this discussion, radiation can be administered in plaques and other surface applicators. Since brachytherapy is superlative for treating a short distance, it makes the surface of any structure within the body ideal for treatment. When we think about plaques, treatment of the eye and the structures within come to mind. All of the structures within the eye are very easily influenced by one another due to their confinement within the globe. The globe of the eye itself is quite small so any radiation administered to this area would have to utilize minute penetration, thus the reasoning behind the development of the eye plaque. Like all ideas in cancer treatment, many research trials and studies must be conducted to establish a standard of care. A choroid melanoma is a growth of the pigmented cells of the choroid of the eye, and it can be highly invasive, metastasize throughout the body, and be very difficult to catch. Choroidal Ocular Melanoma Study (COMS) is a study that compared the treatment outcomes of complete removal of the eye, or enucleation, versus irradiating the eye. By using the COMS eye plaque, built either flat or concave to match the shape of the eye, either iodine-125 or palladium103 are used for irradiation. The ocular tumor is taken to a dose of 85 Gray (Gy) to a depth of 5 millimeters (mm).2 The response of these tumors is based on their size. When dealing with a medium size tumor, treatment with either enucleation or irradiation translate to a success in minimizing metastasis. And if the tumor is large, enucleation is the choice, because the level of radiation necessary to treat a tumor that large, would damage the remaining healthy structures of

the eye. Radiation prior to surgery has also not proven advantageous. I find the COMS research particularly interesting because protons are utilized for ocular treatment for the same reason as using brachytherapy. The precision in both dose delivery and dose falloff is ideal for this region of the body. But, upon further research, I found a surface application of brachytherapy that sparked my interest even further. This is Thermobrachytherapy and was initially used to treat chest wall patients once they had received maximum radiation doses. This tactic is also used to treat large areas of the body with superficial disease that are traditionally difficult to access.

Figure 1. Illustration taken from the Bionix website. This figure demonstrates the layers from internal to external that make up the Bionix Thermobrachytherapy Surface Applicator (TBSA). The square chambers (a) are heating apertures, foam insides that facilitate heated water flow (b), and the vertical lines are the channels that run from the device to the HDR source (c). D demonstrates how the entire TBSA comes together and lays on the patients chest for a chest wall treatment. A study was conducted to determine the feasibility of a concept that provided both microwave hyperthermia (heat) and HDR brachytherapy (radiation). The heat and radiation can be administered either simultaneously or sequentially with this one device.3 I work with a dosimtreist that has used the hyperthermia strategy before, raising the temperature of the previously treated chest wall, and damaging the remaining cancer cells. But, until I came across the TBSA, we were under the impression that brachytherapy and hyperthermia treatments had not become one combined technique.

References 1. Brachy Intro/HDR/Surface Applicators.[SoftChalk]. La Crosse, WI: UW-L Medical Dosimetry Program. 2. Devlin PM. Brachytherapy Applications and Techniques. 1st ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007: 1. 3. Bionix Applied Research website. Thermobrachytherapy surface applicators. http://www.bionix.com/BAR_Pages/ThermoBrachytherapy.html. 2010. Accessed April 23, 2013