eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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vol. 12
Original paper

Feasibility of interstitial stepping-source electronic brachytherapy to locally inoperable tumors

Arne Mathias Ruder
Laurens Inghelram
Frank Schneider
Gustavo R. Sarria
Jürgen Hesser
Frederic Bludau
Udo Obertacke
Frederik Wenz
1, 4
Yasser Abo-Madyan
Frank A. Giordano

  1. Department of Radiation Oncology, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Germany
  2. Department of Data Analysis and Modeling, Mannheim Institute for Intelligent Systems in Medicine, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Germany and Interdisciplinary Center for Scientific Computing (IWR), Heidelberg University, Germany and Central Institute for Computer Engineering (ZITI), Heidelberg University, Germany
  3. Department of Orthopedic and Trauma Surgery, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Germany
  4. University Medical Center Freiburg, Freiburg, Germany
  5. Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Germany
J Contemp Brachytherapy 2020; 12, 5: 480–486
Online publish date: 2020/10/30
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Radiotherapy is the mainstay in the treatment of locally inoperable tumors. Interstitial electronic needle-based kilovoltage brachytherapy (EBT) could be an economic alternative to high-dose-rate (HDR) brachytherapy or permanent seed implantation (PSI). In this work, we evaluated if locally inoperable tumors treated with PSI at our institution may be suitable for EBT.

Material and methods
A total of 10 post-interventional computed tomography (CT) scans of patients, who received PSI and simulated stepping-source EBT applied with Intrabeam system and needle applicator were used. EBT treatment planning software with 3-dimensional image and projection of applicator were applied for designing trajectories and establishing dwell positions. Dwell position doses were summarized, and doses covering 90% of the target volume (D90) achieved with stepping-source EBT were compared to those of PSI. Additionally, conformality of dose distributions and total irradiation time were assessed using conformation number (CN) or conformal index (COIN).

In all patients, D90 of EBT exceeded the prescribed dose or D90 of PSI on average by 4.7% or 21.3% relative to the prescribed dose, respectively. Mean number of trajectories was 5.0 for EBT and 6.9 for PSI. Average CN/COIN for EBT was 0.69, with a mean irradiation time of 27.8 minutes for standardized dose of 13 Gy.

Stepping-source EBT allowed for a conformal treatment of inoperable interstitial tumors with similar D90. Fewer trajectories were required for EBT in majority of cases.


electronic brachytherapy, interstitial brachytherapy, iodine seeds, Intrabeam, stepping source

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