Currently, there are no guidelines available from the American Association of Physicists in Medicine (AAPM) that discuss the breadth and standard of care for surface brachytherapy. For example, the choice of the appropriate applicator, prescription depth, and treatment time for each patient requires a considerable amount of medical physics resources. 10, 11 These 3D applicators have potential to be a more customized solution than the existing commercial flap-style applicators by offering more options for catheter placement, which results in a more customized dose distribution.Įven though treatments with these applicators can be less complex than external-beam-based therapies, numerous challenges exist with the associated commissioning, use, and quality assurance (QA) procedures. Recent publications have also demonstrated the use of three-dimensional (3D)-printed applicators, generated from mechanical models. 5- 7 Thermoplastic mold-style applicators and flap-style applicators 8, 9 are most commonly used with HDR 192Ir sources (and more recently with HDR 60Co sources) and are generally used to treat larger surface lesions that are irregularly shaped. Several vendors offer solid conical applicators for the treatment of shallow tumors (≤5 mm deep) these applicators have been designed for use with radionuclide-based 3, 4 or miniature electronic high dose rate (HDR) brachytherapy (eBT) sources. The number of applicators and approaches for surface brachytherapy has increased markedly over the last decade. Several other advantages of surface brachytherapy include good conformity to patient anatomy (e.g., crevices around the ear, eye, and nose), as well as the convenience of outpatient clinic services with outcomes at least as good as surgery. 1, 2 Surface brachytherapy is the preferred technique for patients with small shallow lesions or large inoperable lesions due to the failure of prior surgeries or other comorbidities. Brachytherapy using solid conical applicators, customized surface molds, and flap-style applicators has been used successfully in the treatment of basal cell carcinoma and squamous cell carcinomas. While mostly replaced as a routine treatment modality in the 1940s and 1950s with low-energy x-ray units, and in the 1970s through the 1990s with electron beams, surface brachytherapy has seen a resurgence recently partially due to the availability of new applicators and treatment approaches. Future directions for surface brachytherapyĪCKNOWLEDGMENTS AND CONFLICTS OF INTERESTīrachytherapy to treat surface lesions has a long history, going back to the turn of the 20th century. Initial workflow and navigation through available treatment modalitiesĥ.C.4. Generalized workflows for surface brachytherapyĥ.A.1. Applicators with radionuclide-based sourcesĥ.A. Catheter-based applications: molds and flapsĤ.D.1. Leipzig-style applicators from VarianĤ.B. Applicators with radionuclide-based sourcesĤ.A.1. DOSIMETRIC CHARACTERISTICS OF APPLICATORSĤ.A. Custom mold- and flap-style applicatorsģ.B. Leipzig- and Valencia-style solid conical applicatorsģ.A.2. Applicators with radionuclide-based sourcesģ.A.1.
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