Brachytherapy (here: high-dose brachytherapy / HDRBT)

Brachytherapy is the local irradiation of lung tumours (bronchial carcinoma) and lung metastases.

The procedure was developed at the Charité around 10 years ago based on an intra-operative radiation technique used back in the 1980s. Compared to conventional radiation techniques, it provides significant benefits in terms of accuracy and depth of effectiveness (invasivity).

Brachytherapy is a form of internal radiotherapy. A solid source of radiation (iridium-192) is inserted into the tumour, under the control of computer tomography. It irradiates the surrounding tumour tissue with gamma rays and destroys it (Figure 1). Very high doses of radiation can be achieved inside the tumour, while the surrounding lung tissue and other organs are protected as much as possible.

With brachytherapy, the doctor’s aim is to inactivate the tumour and therefore reduce the risk of further spread or progression of the disease.

At our hospital, CT-HDRBT is used routinely for the minimally-invasive treatment of inoperable primary lung tumours or metastases.

This treatment can also be useful if thermal destruction (“ablation”, e.g. through RFA) is less effective or is not indicated, for example because the tumours are already lager (> 3 mm in diameter), the tumour lies to close to major blood vessels or the tumour is too well vascularised, which means that tumour cells nearby may not be adequately destroyed due to the transport of heat.

Beforehand

A precise determination of the indication and careful preparation are needed for brachytherapy.

In preparation for the procedure, we evaluate the case history and any diagnostic results already available, such as CT images, MRI scans and, if available, PET-CT scans (positron emission computed tomography). To this end, we request that a detailed medical history is provided, with a list of the treatments already applied, an indication of the progression of the disease, and the most up-to-date diagnostic images available.

Based on the documents supplied, we can check whether the most important requirements for brachytherapy are fulfilled. If this is the case, the patient will be invited for a further consultation and work-up at our outpatient clinic for minimally invasive tumour therapy. You can arrange an appointment for this by calling +49 (0)30 / 450 557 309.

During

We admit the patient to our unit for around three to four days for the treatment.

We generally avoid using general anaesthesia. Based on our experience, brachytherapy of the lungs is tolerated very well by most patients under local anaesthetic and a strong painkiller.

We initially introduce one or more special catheters directly into the tumour under CT guidance. Once the catheter is in place, we carry out a CT scan of the liver. This provides accurate details for the planning of the actual irradiation.

To avoid radiation-related complications such as burns to the skin or inflammation of the lining of the oesophagus, radiation-sensitive structures (such as the oesophagus and spinal cord) are taken into account during the treatment planning and during the actual radiation delivery itself.

After the treatment, the catheter is removed and the incision channel is sealed with a special tissue glue.

The entire procedure takes two to three hours. The actual exposure to radiation takes 10 to 50 minutes, depending on the size of the tumour.

Figure 1: Irradiating a tumour using an after-loading catheter. The entire tumour volume (inner dark blue line) contains a radiation dose of 20 Gray (Gy) (dark red line).

After

After six to eight weeks and then every three months, we recommend a CT scan of the lungs with contrast medium in order to check the outcome of the irradiation and to rule out any new lung tumours.

You can have this CT scan done as an outpatient either at our facility or elsewhere. If the CT scan is carried out elsewhere, we would be grateful if the image data could be sent to us via CD-ROM.

Generally speaking, a single session of therapy is sufficient to treat the tumour. Only in individual cases, e.g. very large tumours or numerous tumour nodes, must the procedure be carried out several times. If the development of new lung tumours is picked up at later follow-up, the procedure can easily be carried out again.

The entire procedure can be carried out with any large skin incisions. However complications can arise in the context of the percutaneous catheter positioning procedure. Injuries to surrounding organs are usually avoided thanks to the CT guidance.

When very large tumours are irradiated, the destruction of the tumour and the body’s own response to this after the procedure can lead to fever, chills and nausea. The symptoms only last for a few hours and can usually be alleviated with medication.

A typical complication of lung treatment is the occurrence of a pneumothorax (collection of air between the lung and the chest wall). This can however be treated very effectively with an aspiration drain (Bülau drain).

Figure 2: Treatment of an inoperable lung metastasis with CT-HDRBT. The first illustration shows the initial lung findings with evidence of a 4 cm metastasis in the right lobe (a). 3D planning of the tumour irradiation following positioning of a catheter under CT guidance (b). After treatment with CT-HDRBT, the CT shows a significant reduction in the size of the metastasis (c). Seven months later, the CT shows a further tumour growth (tumour recurrence) in the treated area (d). The recurrence was again treated with CT-HDRBT (e) successfully (f). (Modified from Collettini et al. (1))

Contact


Minimally Invasive Tumour Therapy (MITT)
Charité Campus Virchow-Klinikum (CVK)
Department of Radiology
Augustenburger Platz 1
13353 Berlin

Collettini F, Schnapauff D, Poellinger A, Denecke T, Banzer J, Golenia MJ, Wust P, Gebauer B. Perkutane CT-gesteuerte Hochdosis-Brachytherapie (CT-HDRBT) von primären und metastatischen Lungentumoren in nicht chirurgischen Kandidaten; Fortschr Röntgenstr 2012; 184(4): 316-323, DOI: 10.1055/s-0031-1299101.

Ricke J, Wust P, Hengst S, Wieners G, Pech M, Herzog H, Felix R. CT-guided interstitial brachytherapy of lung malignancies. Technique and first results. Radiologe. 2004 Jul;44(7):684-6.

Ricke J, Wust P, Wieners G, Hengst S, Pech M, Lopez Hänninen E, Felix R. CT-guided interstitial single-fraction brachytherapy of lung tumors: phase I results of a novel technique. Chest. 2005 Jun;127(6):2237-42.

Peters N, Wieners G, Pech M, Hengst S, Rühl R, Streitparth F, Lopez Hänninen E, Felix R, Wust P, Ricke J. CT-guided interstitial brachytherapy of primary and secondary lung malignancies: results of a prospective phase II trial. Strahlenther Onkol. 2008 Jun;184(6):296-301.