Session Item

The history of radiotherapy has been closely linked to brachytherapy since the beginning. It was recognised early on that bringing the source close to the tumour shrinks it. The characteristic unique feature of brachytherapy, i.e. the introduction of a suitable radioactive source close to the tumour, still offers advantages and possibilities that make this technique essential for radiotherapy today. By using suitable applicators and application technology, it is possible to achieve very good tumour coverage while at the same time sparing the organs at risk, which is difficult or impossible to achieve with teletherapeutic methods. This aspect enables higher doses to be applied and OAR to be spared better than with teletherapy. Studies by Georg et. al. on radiotherapeutic treatment of the prostate have shown that HDR-brachytherapy in particular has advantages over VMAT, scanned proton therapy and scanned carbon-ion therapy. Brachytherapy is very well suited to complement teletherapy as a boost. This is especially true for the treatment of cervical ca where combined tele- and brachytherapy is the recommended therapy. Especially due to the improved imaging, in this case MRI, and 3D-conform planning, a brachy boost can achieve significant improvements. In the EMBRACE I trial, chemoradiotherapy and MRI-based IGABT have been shown to result in effective and stable long-term local control across all stages of locally advanced cervical cancer, with a limited severe morbidity per organ.

Brachytherapy enables small-volume boost treatments for internally inoperable rectal ca, anal ca and head and neck tumours. Apart from curative issues, BT is a suitable remedy of palliation with few side effects for bronchus ca, oesophagus ca and liver metastases.

The positive aspects of BT can be further improved by the application of new techniques. By using 3D printers, applicators can be made that are individually tailored to the patient. In terms of imaging, research is being conducted to ensure that US fused with CT provides adequate planning images to make BT possible even for clinics without MRI access.

Under certain conditions, brachytherapy can be made more cost-effective, as the higher single doses require less fraction than teletherapeutic treatment concepts.

From all these points of view, brachytherapy is therefore not a dying art. It still offers some scope for future research in order to be able to design the treatment even better and will continue to develop and coexist with other forms of therapy.