Since the last edition of this textbook, interventional radiation therapy (brachytherapy) has undergone significant developments. The incorporation of advanced image-guiding procedures and the establishment of new applicators allow for the highly accurate implantation of complex implants. 3D-guided real-time adaptive brachytherapy is becoming the newest clinical standard. We now find ourselves in an exciting new era of brachytherapy. The current edition of this textbook has been updated to include all these new developments in brachytherapy, including the results of recent clinical trials and updates to the brachytherapy guidelines by the European Brachytherapy Group within ESTRO (GEC-ESTRO). A number of highly experienced authors and skilled colleagues from all over Europe have contributed to this edition to educate and inspire all members of the radiation oncology team to utilise the full potential of brachytherapy to the benefit of their patients.

Inhalt
1.Introduction21 2.History of brachytherapy22 3.Physical aspects sources, dosimetry and dose specification28 3.1.Sources28 3.1.1.Radionuclides in brachytherapy28 3.1.1.1.Gamma and characteristic X-ray radiation28 3.1.1.2.Beta-emitters29 3.1.2.Characterisation of source strength29 3.2.Dosimetry29 3.2.1.Control of reference air kerma rate29 3.2.1.1.Measurement with well-type ionisation chambers29 3.2.1.2.Measurement in compact chambers in solid body phantoms29 3.2.2.Checking the source position30 3.2.3.Calculation of dose distributions30 3.2.3.1.Dose distributions of single sources30 3.2.3.2.Applicator reconstruction31 3.2.4.Optimisation and visualisation of dose distributions33 4.Quality assurance38 4.1.Quality assurance for afterloading devices and procedures in case of emergency for a remote afterloader38 4.2.Quality assurance in brachytherapy treatment planning systems41 4.3.Special methods41 5.Dosimetrical aspects dose specifications, dose-volume definitions, EQD2 concept46 5.1.Dose specification in general46 5.2.Dose specification in intraluminal and intracavitary therapy47 5.2.1.Source positions along one straight line (e.g. vaginal cylinder, oesophageal/bronchial applicators, vessels)47 5.2.2.Advanced cervical carcinoma48 5.2.3.Endometrial carcinoma not treated surgically48 5.3.Dose specification in interstitial brachytherapy48 5.3.1.Point based systems48 5.3.2.Dose and volume relations, Dose-volume histograms (DVH) and quality parameters (indices)50 5.3.2.1.Relevant dose values and volumes50 5.3.2.2.Quality parameters QI indices51 5.4.Dose fractionation, combination with external beam and the EQD2 concept53 6.Clinical treatment planning and imaging56 6.1.Clinical treatment planning56 6.1.1.Indication56 6.1.1.1.Definitive treatment56 6.1.1.2.Adjuvant therapy56 6.1.2.Gross Target Volume (GTV) and Clinical Target Volume (CTV)56 6.1.3.Selection of technique, preliminary and definitive treatment plan57 6.1.3.1.Interstitial brachytherapy57 6.1.3.2.Intracavitary brachytherapy60 6.1.3.3.Intraluminal brachytherapy60 6.1.4.Dose, dose fractionation, dose rate60 6.1.5.Infrastructure and personnel planning61 6.2.Modern imaging techniques in brachytherapy62 6.2.1.Basics of image-guided brachytherapy62 6.2.2.Image-guided preliminary treatment planning64 6.2.3.Image-guided application64 6.2.4.Image-guided definitive treatment planning65 6.2.5.Imaging techniques in brachytherapy66 6.2.5.1.CT imaging66 6.2.5.2.MR imaging67 6.2.5.3.US imaging67 7.Instruments and equipment69 7.1.Instruments for interstitial brachytherapy69 7.1.1.Temporary implants69 7.1.1.1.Needles, catheters69 7.1.1.2.Templates71 7.1.1.3.Auxiliary instruments73 7.1.2.Permanent implants74 7.2.Instruments for intracavitary brachytherapy75 7.2.1.Uterovaginal applicators75 7.2.2.Vaginal applicators76 7.2.3.Endometrial applicators77 7.2.4.Intraluminal applicators for tumours in the oesophagus, bronchus, trachea, common bile duct and nasopharynx and for intravascular brachytherapy77 7.2.5.Moulds for cancers of the paranasal sinuses or orbit78 7.3.Surface applicators78 7.3.1.Skin applicators78 7.3.2.Eye applicators79 7.4.Afterloading devices79 7.4.1.The irradiation device80 7.4.2.The control unit81 7.4.3.Important requirements for radiation protection81 8.Intra- and perioperative brachytherapy82 8.1.Introduction82 8.2.Indications and patient selection criteria83 8.2.1.Intraoperative brachytherapy83 8.2.2.Perioperative brachytherapy84 8.3.Practical execution and technique, practical tips85 8.4.Treatment planning87 8.4.1.Target volumes, dose specification and dose, QA87 8.5.Results88 8.6.Side effects89 8.6.1.Short-term toxicity89 8.6.2.Long-term toxicity89 8.7.Summary90 9.Interstitial hyperthermia91 9.1.Techniques of interstitial hyperthermia91 9.2.Planning, performance and documentation of interstitial hyperthermia91 9.3.Quality and effectiveness of hyperthermia92 9.4.Treatment results in interstitial brachytherapy and hyperthermia92 9.4.1.Glioblastoma92 9.4.2.Local and locoregional recurrences of head and neck cancer93 9.4.3.Breast cancer94 9.4.4.Tumours of the small pelvis94 9.4.5.Prostate cancer94 9.6.Summary95 10.Pre- and postoperative supportive care in brachytherapy97 10.1.Patient preparation97 10.2.Anaesthesia and patient positioning97 10.3.Pain management98 10.4.Anti-infective therapy98 10.5.Prophylaxis of thrombosis99 10.6.Pre- and postoperative supportive care by specific tumour sites99 10.6.1.Head and neck cancer99 10.6.2.Breast cancer100 10.6.3.Prostate cancer100 10.6.4.Gynaecological tumours101 10.7.Follow-up102 11.Cervical cancer103 11.1.Indications103 11.2.Brachytherapy pre-planning103 11.2.1.Brachytherapy target volumes103 11.2.2.Organs at risk105 11.2.3.Dose optimisation105 11.2.4.Dose, dose rate, fractionation112 11.3.Technique of applicator insertion112 11.4.Results113 11.4.1.Concomitant chemoradiotherapy113 11.5.Side effects114 11.6.Summary114 12.Endometrial carcinoma117 12.1.Indications, patient selection criteria117 12.1.1.Current Indications for adjuvant radiotherapy, including Brachytherapy117 12.1.1.1.Low risk endometrial cancer117 12.1.1.2.Intermediate risk endometrial cancer117 12.1.1.3.High to intermediate risk endometrial cancer118 12.1.1.4.High risk endometrial cancer118 12.1.1.5.Adjuvant intravaginal brachytherapy119 12.1.2.Brachytherapy in primary endometrial carcinoma119 12.1.3.Intracavitary and interstitial brachytherapy for recurrences119 12.2.Treatment planning120 12.2.1.Target volumes120 12.2.1.1.Adjuvant intracavitary brachytherapy120 12.2.1.2.Primary brachytherapy121 12.2.1.3.Interstitial brachytherapy in recurrent disease122 12.2.2.Dose specification122 12.2.2.1.Adjuvant brachytherapy122 12.2.2.2.Primary brachytherapy123 12.2.2.3.Interstitial brachytherapy123 12.2.3.Dose, dose rate, fractionation123 12.3.Practical execution and technique124 12.3.1.Adjuvant brachytherapy124 12.3.2.Primary brachytherapy124 12.3.3.Interstitial brachytherapy124 12.4.Results125 12.5.Side effects125 12.6.Summary126 13.Primary vaginal carcinoma128 13.1.Indications128 13.2.Brachytherapy pre-planning128 13.2.1.Target volume128 13.2.2.Organs at risk130 13.2.3.Dose planning130 13.2.4.Dose, dose rate and fractionation131 13.2.4.1.Planning aims for the target volumes131 13.2.4.2.Dose constraints for the organs at risk132 13.3.Practical execution and technique132 13.4.Results133 13.5.Side effects133 13.6.Summary134 14.Vulvar carcinoma135 14.1.Indications, patient selection criteria136 14.2.Treatment planning136 14.2.1.Target volumes136 14.2.2.Dose specification137 14.2.3.Dose, dose rate, fractionation138 14.3.Practical execution and technique138 14.4.Results140 14.5.Side effects140 14.6.Summary141 15.Carcinoma of the female urethra142 15.1.Indications, patient selection criteria142 15.2.Treatment planning142 15.2.1.Target volumes142 15.2.2.Dose specification142 15.2.3.Dose, dose rate, fractionation143 15.3.Practical execution and technique143 15.4.Results144 15.5.Side effects144 15.6.Summary145 16.Carcinoma of the prostate146 16…