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Review
. 2009 Mar;1(1):5-10.
Epub 2009 Mar 23.

Boost in radiotherapy: external beam sunset, brachytherapy sunrise

Boguslaw Maciejewski  1
Affiliations
Review

Boost in radiotherapy: external beam sunset, brachytherapy sunrise

Boguslaw Maciejewski. J Contemp Brachytherapy. 2009 Mar.

Abstract

Radiobiological limitations for dose escalation in external radiotherapy are presented. Biological and clinical concept of brachytherapy boost to increase treatment efficacy is discussed, and different methods are compared. Oncentra Prostate 3D conformal real-time ultrasound-guided brachytherapy is presented as a solution for boost or sole therapy.

Keywords: boost techniques; brachytherapy; radiobiological rationale.

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Figures

Fig. 1
Fig. 1
RTOG 88-13 illustrates “effect plateau” – increase in total dose with extension overall treatment time total doe with extension overall treatment time does not improve locoregional control (TCP) because of accelerated repopulation with increasing Drep even to 1.6 Gy/day towards the end of treatment longer than 6 weeks
Fig. 2
Fig. 2
Theoretical cell survival curve for fractionated irradiation. Solid line represents population of homogenously sensitive tumour cells, and each dose fraction results in the same cell kill rate. Dotted lines represent different subpopulations of more or less resistant cells which produce “resistant tail” in the survival curve. (a) DVH with homogenous dose 14 distribution for tumour with heterogeneous cellular pattern results in the decrease of the planned TCP of 90% to even 0%. (b) Heterogeneous tumours need heterogeneous DVH with the “boost-tail” to eradicate resistant cells and to keep TCP at the assumed level of 90%
Fig. 3
Fig. 3
Scheme of simultaneous infield boost (SIB) within the PTV. SIB area receives an extra (boost) dose with each fraction. Because number of fractions and overall treatment time are constant for a given treatment the only variable is dose per fraction which produces in the SIB area higher total dose (boost) than in the remaining PTV
Fig. 4
Fig. 4
Scheme of organization of the Department of Radiotherapy (RTL) and Brachytherapy (BTL) connected with Treatment Planning Dept. (Div.) through RTL & BTL Directory (QA – quality assurance audits)
Fig. 5
Fig. 5
Dependence of tumour control on boost advantages and on geographical or radiation delivery errors. Dose missing (cold dates) resulting in decrease of the TCP can never be corrected by the boost strategy
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References

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