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Brachytherapy Surface Applicators

Carcinomas of the skin account for nearly one third of all cancers diagnosed in the United
States each year, and there is an estimated incidence of 800,000 new cases each year.
1
Exposure
to ultraviolet solar radiation is the most common cause of skin cancer, but other factors include
genetic predisposition, arsenic exposure and preexisting chronic skin ulcers related to syphilis or
burns. The size, diameter, depth of invasion and multifocality of the tumor must be precisely
defined at the time of diagnosis to determine whether a patient should receive surgery,
chemotherapy, radiation or a combination of the three.
I do not have any experience with surface applicators for any sort of treatment, as the
institution where I completed my therapy school had an orthovoltage machine that was utilized
for surface treatments, and Loyola no longer has surface applicators for HDR treatment.
Surface-dose applications are sometimes referred to as plesiocurie or mold therapy and consist of
an applicator containing an array of radioactive sources designed to deliver a uniform dose
distribution to an intraoperative tumor bed, skin, or mucosal surface.
1
External applicators can be
molded to fit snugly on the surface of the affected area, with specified areas for radioisotope
placement.
2

Varian makes a device called the catheter flap set that is used for treating superficial
lesions.
3
It creates a defined space between the source and tissue and between source channels.
Its made out of highly flexible material, and almost looks like the bolus we use at Loyola for
electron treatments, except it has a space to insert catheter wires. The flexibility of the material
allows it to be draped across almost any anatomical area, and can be re-used with each patient.
The physicist and physician must determine which source channels will be utilized for treatment
to create a uniform dose. It is compatible with the Varian afterloader GammaMedplus. Elekta
has a similar system called the Freiburg Flab, seen in Figure 1.
Loyola recently purchased IntraBeam Radiotherapy System which is used for
intraoperative radiation therapy.
4
It was purchased very recently and has been used for one
intraoperative treatment to treat a tumor bed after breast conservation surgery. The idea is that
this treatment replaces the need for the boost treatment that would typically follow whole breast
radiation, so it doesnt totally eliminate the need for external beam radiation. Although delivered
in the operating room while the patient is still under anesthesia, our physicist compared the
applicator used for that method to a surface applicator. The applicator is placed directly against
the tissue surrounding the tumor bed to deliver a uniform dose to the surface.

Figures


Figure 1. Example of the source channels used for mold RT.

Figure 2. Example of the Freiburg system being used for a superficial treatment.


Figure 3. Image of the IntraBeam Radiotherapy System used to treat tumor beds.
References
1. Chao KS, Perez CA, Brady LW. Radiation Oncology Management Decisions. 3
rd
ed.
Philadelphia, PA: Lippincott, Williams & Wilkins; 2011.
2. Washington CM, Leaver D. Principles and Practice of Radiation
Therapy. 3rd ed. St. Louis, MO: Mosby-Elsevier; 2010.
3. Varian. Varian Brachytherapy, Applicators and Accessories.
http://www.varian.com/media/oncology/brachytherapy/pdf/VBT_Applicator_Catalogue.p
df. Updated 2011. Accessed April 23, 2014.
4. Sutter Health. Intrabeam Radiotherapy System (IORT).
http://www.altabatessummit.org/technology/intrabeam-radiotherapy.html. Updated 2013.
Accessed April 23, 2014.