Modern Brachytherapy in the Treatment of Prostate Cancer
DOI:
https://doi.org/10.12974/2309-6160.2013.01.01.5Keywords:
Brachytherapy, HDR, LDR, prostate cancer, seeds.Abstract
There are several therapeutic modalities that can be performed in order to treat prostate cancer, such as: external beam radiation therapy (EBRT), prostatectomy, cryotherapy or interstitial brachytherapy (BT). Brachytherapy of prostate cancer is one of the oldest methods and means implantation of radioactive sources directly into the prostate. Brachytherapy is a curative alternative of radical prostatectomy or external beam radiation (i.e. 3D conformal external beam radiation therapy (CRT), Intensity Modulated Radiation Therapy (IMRT)) with comparable long-term survival and biochemical control and most favorable toxicity. Low-dose rate brachytherapy (LDR-BT) is one of the radiation methods that is known for several years in treatment of localized prostate cancer. The main idea of this method is to implant small radioactive seeds as a source of radiation, directly into the prostate gland. Modern high-dose-rate brachytherapy (HDR-BT) of prostate cancer enables the delivery of a very high single or multiple dose of radiation to the target volume (e.g. prostate capsule) and, at the same time, preventing the organs at risk from unnecessary radiation (e.g. urethra and rectal wall). Although initially LDR-BT was favored for low risk prostate cancers, and HDR-BT for intermediate and advanced disease, both types of brachytherapy now have a place across all the risk groups of localized prostate cancer. This article will review indications and patient selection, planning and technical aspects, toxicity and efficacy for both techniques. Possible similarities and differences between both brachytherapy modalities are discussed.
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