Abstract
Brachytherapy (BT) has long been used for successful treatment of various tumour entities, including prostate, breast and gynaecological cancer. However, particularly due to advances in modern external beam techniques such as intensity-modulated radiotherapy (IMRT), volume modulated arc therapy (VMAT) and stereotactic body radiotherapy (SBRT), there are concerns about its future. Based on a comprehensive literature review, this article aims to summarize the role of BT in cancer treatment and highlight its particular dosimetric advantages. The authors conclude that image-guided BT supported by inverse dose planning will successfully compete with high-tech EBRT in the future and continue to serve as a valuable modality for cancer treatment.
Highlights
Brachytherapy (BT) has a long history of successful use in the treatment of various cancers with excellent clinical outcomes, but its use rate within radiotherapy has varied over time
We found one study for brain and head and neck, two for lung, three for liver, six for skin and eight for breast tumours
In modern external beam radiation therapy (EBRT), such as stereotactic radiosurgery (SRS) or stereotactic body radiotherapy (SBRT), small fields or small beam segments are usually used for generating intensity modulation, where the dose gradient perpendicular to the beam direction is very steep at the beam edges
Summary
Brachytherapy (BT) has a long history of successful use in the treatment of various cancers with excellent clinical outcomes, but its use rate within radiotherapy has varied over time. Evidence suggests that BT is considered mandatory in the treatment of locally advanced cervical cancer, and concerns have been raised that some physicians are trying to replace it with an EBRT boost [12]. According to an analysis of the National Cancer Data, use of BT in the treatment of cervical cancer in the USA has decreased, while at the same time, use of IMRT and SBRT increased significantly between 2004 and 2011, and the IMRT or SBRT boost resulted in poorer overall survival compared to BT [2]. The aim of the present study is to provide a dosimetric overview of the role of BT in the treatment of different anatomical sites of cancer patients in the age of advanced external beam radiotherapy. Following a thorough literature search, the dosimetric assessment was based on a review of relevant publications and our own experience
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