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Book Review
Brachytherapy Physics, 2nd ed., edited by Bruce R. Thomadsen, Mark J. Rivard, and Wayne M. Butler, AAPM Medical Physics Monograph #31, Medical Physics Publishing, 2005, ISBN 10: 1-930524-24-2, list price $140 (AAPM member), $175 (all others)
This book contains the proceedings of the Summer
School on Brachytherapy, jointly organized by the American
Association of Physicists in Medicine (AAPM) and the American
Brachytherapy Society (ABS). The last AAPM Summer School on
Brachytherapy was held in 1994,(1) so
the physical and clinical aspects of brachytherapy have changed
significantly since that time. A greater understanding of how to
accurately determine source dosimetry parameters has led to many
advances either by using theoretical calculations such as Monte
Carlo methods or in the design of experimental measurements of
brachytherapy dosimetry parameters in terms of phantom composition
and dimensions and dosimeter selection and calibration procedures.
Advancements have also been made in the analyses of experimental
uncertainties. The emergence of transrectal ultrasound-guided
permanent prostate interstitial brachytherapy for early-stage
prostate cancer has led to the development and manufacturing of
several new low-energy brachytherapy sources. In response, much
effort has been spent gaining a detailed understanding of the
dosimetric characteristics of these sources, which is reflected in
the volume of publications by the Low Energy Interstitial
Brachytherapy Dosimetry subcommittee of the AAPM Therapy Physics
Committee, which updated the AAPM TG43 report.(2,3)
A
new national source strength standard, the National Institute of
Standards and Technology Wide-Angle Free-Air Chamber system,(4) has been accepted for the general source
strength of such sources. Advances in volumetric imaging, in the
capability of treatment-planning systems to use such images, and in
optimization methods have led to greater use of image-guided
brachytherapy techniques. The high-dose rate (HDR) remote
afterloading technique has begun to replace the conventional
low-dose rate (LDR) technique in the delivery of brachytherapy
treatments to a variety of clinical sites, such as with gynecologic,
prostate, and other intraluminal and interstitial treatments.
Accelerated partial breast irradiation techniques using interstitial
implants or intracavitary placement of a balloon (MammoSite) are
gaining general acceptance in the management of early-stage breast
cancer following lumpectomy. Intravascular brachytherapy emerged as
the most popular treatment of coronary vessel stenosis, only to be
largely replaced by the use of drug-emitting stents. Finally,
unconventional delivery techniques such as 90Y-impregnated microspheres for treatment
of liver metastasis and radiolabeled antibody therapy techniques
such as Zevalin and Bexxar for treatment of lymphomas are now
delivered at radiation oncology departments instead of at nuclear
medicine departments, thus adding to the expectations for an
additional knowledge base for clinical brachytherapy physicists.
The proceedings of the 2005
AAPM/ABS summer school could not have come at a more opportune time.
Compared with the 1994 volume, the current book provides updated
information on source strength calibration methods, brachytherapy
source characteristics, and dose calculation formalisms contributed
by the authors of relevant AAPM task group reports on these topics.
Several well-written chapters are devoted to the concepts of
classical implant systems (Manchester, Quimby, and Paris).
Additional chapters describe general clinical applications such as
implant design, treatment plan review, and postimplant quality
evaluation, which were previously available only in diffused
literature. These proceedings have placed a much greater emphasis,
and have provided detailed discussions, on clinical topics such as
image-guided gynecologic implants, LDR permanent as well as HDR
temporary prostate implants, and accelerated partial breast
irradiation using both the interstitial and intracavitary
techniques. There are several chapters on advanced 3D image-based
brachytherapy; however, most of the information is limited to the
current state-of-the-art in HDR treatment techniques. Prostate
brachytherapy, which was covered in a single chapter in the previous
summer school proceedings, is now covered in six chapters with a
plethora of detailed and clinically useful information. The chapters
on regulatory aspects of brachytherapy and brachytherapy facility
design provide a broader insight into the topic and contain the most
current information on revisions made to the federal regulations on
the medical use of brachytherapy sources over the past several
years.
The book also attempts to
achieve a balance between theoretical studies and clinical
applications of brachytherapy. While the authors of the chapters are
well-known researchers in brachytherapy physics, many of the other
chapters' contributors are clinical brachytherapy physicists. This
has resulted in a balanced presentation of both the future trends in
brachytherapy research and the current status of clinical
brachytherapy physics.
Given the
diversity in clinical implementation of brachytherapy techniques, it
is not surprising that the book is unable to provide discussions on
several emerging aspects of clinical brachytherapy applications,
including the use of functional imaging techniques such as PET and
MRS for brachytherapy treatment planning and delivery, and
image-based tandem and ovoid treatments of cervical cancer,
especially in how their applications may change the prescription and
treatment planning of such implants. It is also missing discussions
on the combined use of brachytherapy and external beam treatments.
Finally, the summer school proceedings took a narrower definition of
brachytherapy by only including techniques that use sealed sources
(with the exception of the microspheres). It does not describe the
emerging clinical techniques of radiolabeled antibody therapy.
Because demand for such treatment options is directed toward
radiation oncology departments, guidelines on source preparation,
dosimetry, and delivery techniques are of the utmost importance to
clinical physicists. These omissions notwithstanding, the second
edition of Brachytherapy Physics provides an update and
detailed information on brachytherapy dosimetry principles and
clinical techniques that could not have come at a more opportune
time. These are challenging times for brachytherapy physicists, with
the rapid clinical implementation of new brachytherapy procedures in
a variety of disease sites, and they will be well-served by this
book.
REFERENCES
- Brachytherapy Physics, Williamson JF, Thomadsen BR, and Nath R. eds. Madison (WI): Medical Physics Publishing; 1995.
- Nath R, et al. Dosimetry of interstitial brachytherapy sources. Med Phys. 1995;22:209-234.
- Rivard MJ, Coursey BM, DeWerd LA, et al. Update of AAPM Task Group No. 43 Report: A revised AAPM protocol for brachytherapy dose calculations. Med Phys. 2004;31:633-674.
- Loevinger R. Wide-angle free-air chamber for calibration of low energy brachytherapy sources. Med Phys. 1993;20:907.
Professor and Chief of Physics
Department of
Radiation Oncology
University of Florida
Gainesville, Florida
32610 U.S.A.
© 2006 Am. Coll. Med. Phys.