Comparison of intracavitary brachytherapy and stereotactic body radiotherapy dose distribution for cervical cancer
Mustafa CengizA. DoganGökhan ÖzyiğitE. ErturkFerah YıldızUğur SelekŞükran ÜlgerFatma ÇolakFaruk Zorlu
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Although the value of stereotactic radiosurgery for the treatment of brain tumours in children is well recognized, the widespread use of stereotactic radiosurgery in paediatrics has been limited by difficulties with rigid fixation for young children, the need for general anaesthesia, and certain characteristics of some paediatric brain tumors which may promote the risk of radionecrosis. The CyberKnife radiosurgery system is both frameless and precise and therefore offers potential solutions to these problems. We review the advantages of frameless radiosurgery for paediatric patients, discuss factors specific to CyberKnife stereotactic radiosurgery for children, and report our preliminary experience with a group of 21 patients.
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Treatment planning in both teletherapy and brachytherapy is time consuming practice but accurate determination of planning parameters is more important. This paper aims to verify the dose delivery time for the treatment of vaginal cancer, which is a vital parameter of High Dose Rate (HDR) brachytherapy treatment planning. Treatment time has been calculated by the computerized treatment planning system (ABACUS 3.1), and then it has been compared with the manually calculated time. The results obtained are in good agreement. Independent verification of nominal time by two different protocols assures the quality of treatment. This should always be practiced to increase the accuracy of treatment.
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Classic radiosurgery is a neurosurgical treatment concept for single-fraction irradiation of cerebral lesions not amenable to open surgery. Until recently it has been realized mainly by frame-based technologies (Gamma Knife; stereotactic linear accelerators). The CyberKnife described in 1997 is an image-guided frameless robotic technology for whole-body radiosurgery. It can be used for classic single-fraction radiosurgery and for hypofractionated treatments. The CyberKnife treatment procedure is completely non-invasive and can be repeated throughout the body if necessary. Brain metastases are an important and frequently treated indication of modern radiosurgery. Data concerning radiosurgical treatment of brain metastases with the CyberKnife are reviewed. Scientific evidence shows that the full-body applicability of the CyberKnife is not at the expense of an inferior intracranial treatment quality when compared to standard frame-based technology. The clinical results of CyberKnife single-fraction radiosurgery are in line with the published literature. The attractive therapeutic profile of CyberKnife radiosurgery is reflected by a high tumor control and a low toxicity and the repeatability of the treatments for recurrent metastases. Although hypofractionated treatments (in 3–5 fractions) of brain metastases have been performed with the CyberKnife to treat large metastases, the clinical significance of this new radiosurgical concept is unclear and requires further study. A new approach is to treat the resection cavity with radiosurgery after surgical removal of brain metastases. In this concept radiosurgery replaces fractionated radiation therapy as an adjunct to surgery. The initial results are very promising. The CyberKnife has been established as a modern non-invasive technology for intra- and extracranial radiosurgery. It adds to the oncological armamentarium and confers upon radiosurgery a greater emphasis as an oncological treatment concept.
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Brachytherapy has evolved over many decades, but more recently, there have been significant changes in the way that brachytherapy is used for different treatment sites. This has been due to the development of new, technologically advanced computer planning systems and treatment delivery techniques. Modern, three-dimensional (3D) imaging modalities have been incorporated into treatment planning methods, allowing full 3D dose distributions to be computed. Treatment techniques involving online planning have emerged, allowing dose distributions to be calculated and updated in real time based on the actual clinical situation. In the case of early stage breast cancer treatment, for example, electronic brachytherapy treatment techniques are being used in which the radiation dose is delivered during the same procedure as the surgery. There have also been significant advances in treatment applicator design, which allow the use of modern 3D imaging techniques for planning, and manufacturers have begun to implement new dose calculation algorithms that will correct for applicator shielding and tissue inhomogeneities. This article aims to review the recent developments and best practice in brachytherapy techniques and treatments. It will look at how imaging developments have been incorporated into current brachytherapy treatment and how these developments have played an integral role in the modern brachytherapy era. The planning requirements for different treatments sites are reviewed as well as the future developments of brachytherapy in radiobiology and treatment planning dose calculation.
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Since its introduction nearly 60 years ago, stereotactic radiosurgery has become the standard of care for the noninvasive destruction of intracranial tissues or lesions that may be inaccessible or unsuitable for open surgery. Today, modern stereotactic radiosurgery is practiced using advanced image guided treatment planning and specialized delivery systems including micro‐ MLC equipped linacs, CyberKnife, and Gamma Knife machines. Stereotactic radisourgery delivers a large dose to a precisely defined volume in a short time, and as such requires the utmost attention to precision and quality assurance. Also critical is the meticulous design of treatment processes that eliminate the possibility of potentially disastrous errors. In this presentation we review the fundamental aspects of stereotactic targeting and delivery, the technologies for stereotactic localization and treatment of cranial targets, and the quality assurance aspects associated with establishing and maintaining a clinical radiosurgery program. Examples of radiosurgery cases will be presented from the best practice sites utilizing Gamma Knife, CyberKnife, and linac delivery systems, followed by an expert panel discussion of quality measures for treatment planning and delivery. Learning Objectives: 1. Differentiate how radiation is delivered for Gamma Knife, CyberKnife and Linac‐based (conventional and robotic) stereotactic radiosurgery. 2. Define the treatment planning parameters, imaging requirements and workflow for Gamma Knife, CyberKnife and Linac‐based stereotactic radiosurgery. 3. Discuss measures for assuring accuracy in stereotactic localization and dose delivery for Gamma Knife, CyberKnife and Linac‐based stereotactic radiosurgery. 4. Discuss uncertainties and limitations associated with Gamma Knife, CyberKnife and Linac‐based stereotactic radiosurgery
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Stereotactic radiosurgery is a non-invasive technique that utilizes precisely targeted radiation as an alternative surgical tool. Conventional radiosurgery devices, such as Gamma Knife and X-Knife, rely upon skeletally attached stereotactic frames to immobilize the patient and accurately localize intracranial neoplasm. The CyberKnife (Accuray, Inc., Sunnyvale, California), a new and revolutionary stereotactic radiosurgery instrument, makes it possible to administer radiosurgery without a frame. The superiorities of the CyberKnife, including real-time image-guided irradiation and dynamic synchronous tracking, extend stereotactic radiosurgery for a range of extracranial tumors and some non-neoplastic disorders. This paper reviews CyberKnife technology and its clinical application in intracranial neoplasm and extracranial tumors.
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