REVIEW  IMAGE-GUIDED SURGERY: FROM CLASSICAL TECHNIQUES TO NOVEL ASPECTS AND APPROACHES Free access

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2021 September;65(3):190-201

DOI: 10.23736/S1824-4785.21.03370-7

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Therapeutic applications of radioactive sources: from image-guided brachytherapy to radio-guided surgical resection

Leah R. DICKHOFF ¹ ✉, Marie-Jeanne VRANCKEN PEETERS ^{2, 3}, Peter A. BOSMAN ⁴, Tanja ALDERLIESTEN ¹

¹ Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands; ² Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands; ³ Department of Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands; ⁴ Life Sciences and Health Group, Centrum Wiskunde & Informatica, Amsterdam, the Netherlands

It is well known nowadays that radioactivity can destroy the living cells it interacts with. It is therefore unsurprising that radioactive sources, such as iodine-125, were historically developed for treatment purposes within radiation oncology with the goal of damaging malignant cells. However, since then, new techniques have been invented that make creative use of the same radioactivity properties of these sources for medical applications. Here, we review two distinct kinds of therapeutic uses of radioactive sources with applications to prostate, cervical, and breast cancer: brachytherapy and radioactive seed localization. In brachytherapy (BT), the radioactive sources are used for internal radiation treatment. Current approaches make use of real-time image guidance, for instance by means of magnetic resonance imaging, ultrasound, computed tomography, and sometimes positron emission tomography, depending on clinical availability and cancer type. Such image-guided BT for prostate and cervical cancer presents a promising alternative and/or addition to external beam radiation treatments or surgical resections. Radioactive sources can also be used for radio-guided tumor localization during surgery, for which the example of iodine-125 seed use in breast cancer is given. Radioactive seed localization (RSL) is increasingly popular as an alternative tumor localization technique during breast cancer surgery. Advantages of applying RSL include added flexibility in the clinical scheduling logistics, an increase in tumor localization accuracy, and higher patient satisfaction; safety measures do however have to be employed. We exemply the implementation of RSL in a clinic through our experiences at the Netherlands Cancer Institute.

KEY WORDS: Radioactivity; Iodine-125; Brachytherapy; Surgical procedures, operative