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Endovascular brachytherapy — Treatment planning and radiation protection

Bestrahlungsplanung und Strahlenschutz der endovasalen Brachytherapie

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Abstract

The risk of restenosis, main late effect limiting the success of percutaneous transluminal coronary artery angioplasty, can be reduced significantly by vascular radiotherapy, subsequent to PTCA. This discovery lead to the development of new irradiation techniques. Endovascular brachytherapy is the choice in treatment of coronary artery stenosis. Successful irradiation, however, requires precise treatment planning. This review addresses the physical possibilities and problems of intravascular brachytherapy planning, and the radiobiologically based definition of the target volume and of structures at risk. Recommendations for dose specification, recording and reporting are given. The criteria for selecting a vascular radiotherapy technique are discussed as well as the possibilities of dosimetric treatment planning and quality assurance based on precise plastic scintillator dosimetry and intravascular ultrasound. Radiation protection and safety must be reconsidered prior to the usage of therapeutic radiation sources in the catheter laboratory and for the decision about emergency plans. Finally, the design of clinical trials, the role of medical physicists, and the future of irradiation treatment of stenosis is discussed.

Zusammenfassung

Die Restenosierung begrenzt als wesentliche Spätreaktion den Erfolg der perkutanen transluminalen Koronarangioplastie (PTCA) bei der Behandlung von Atherosklerosen. Doch jüngste tierexperimentelle und erste klinische Studien bestätigen, daß durch eine vaskuläre Strahlentherapie mit niedrigen Strahlendosen um 20 Gy die Wahrscheinlich der Restenosierung stark gesenkt werden kann. Diese Ergebnisse haben eine stürmische Entwicklung auf dem Gebiet der endovasalen Brachytherapie ausgelöst. Viele neue Bestrahlungstechniken und Strahlenquellen sind entwickelt worden. Die endovasale Brachytherapie mit hochenergetischen Betastrahlern oder niederenergetischen Photonenstrahlern ist zur Behandlung der Koronararterien am besten geeignet, während für die weiteren, peripheren Gefäße Photonen höherer Energie benötigt werden. Voraussetzung zur erfolgreichen Strahlenbehandlung ist die sorgfältige Bestrahlungsplanung. Neue biologische Erkenntnisse zeigen, daß die gesamte Wandung (einschließlich der Adventitia) des durch die interventionelle Maßnahme geschädigten Gefäßabschnittes das Zielvolumen der Strahlentherapie ist. Zur individuellen Bestrahlungsplanung ermöglicht die intravaskuläre Ultraschalltomografie (IVUS) die genaue Lokalisation, während die hochauflösende Plastikszintillator-Dosimetrie die exakte Messung der räumlichen Dosisverteilung endovasaler Strahlenquellen erlaubt. Die Möglichkeiten und Probleme der endovasalen Bestrahlungsplanung werden in dieser Übersicht diskutiert, die Definition von Zielvolumen und Risikostrukturen, die internationalen Empfehlungen zur Strahlerkalibrierung und_-charakterisierung, zur Dosisspezifikation und Dokumentation, die Leistungsfähigkeiten der IVUS-Lokalisation und Plastikszintillator-Dosimetrie zur schnellen dosimetrischen Bestrahlungsplanung sowie die Anforderungen an Strahlenschutz und Sicherheit, an klinische Studien und Routineanwendungen.

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Authors and Affiliations

  1. Klinische Strahlenphysik, Abteilung für Strahlentherapie, Universitätsklinikum, D-45122, Essen, Germany

    Ulrich Quast, Dirk Flühs & Markus Bambynek

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  1. Ulrich Quast
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Correspondence to Ulrich Quast.

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Quast, U., Flühs, D. & Bambynek, M. Endovascular brachytherapy — Treatment planning and radiation protection. Herz 23, 337–346 (1998). https://doi.org/10.1007/BF03043598

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