INTERSTITIAL IMPLANTATION TECHNIQUES IN PROSTATE-CANCER

Brachytherapy is a radiotherapeutic technique that allows the physicia n to implant radioactive isotopes into a body cavity or directly into tissue. Different radioisotopes have unique characteristics that the b rachytherapist may utilize for a particular situation. The use of brac hytherapy is part of standard radiation oncology practice in gynecolog ical and head and neck cancer management. The prostate is approachable for interstitial implantation due to its close proximity to the perin eum. Over 20 years ago, primitive methods of brachytherapy were utiliz ed in the treatment of prostate cancer. However, poor results due to i nconsistency in achieving adequate coverage of the entire prostate and poor patient selection caused this treatment modality to fall out of favor. Technological advances over the last decade have restored atten tion to brachytherapy for prostate cancer. Particularly important has been the development of transrectal ultrasound, new radioisotopes such as palladium-103, computer tomography, computerized dosimetry systems , and earlier diagnosis. Modern interstitial implantation utilizing tr ansperineal template and transrectal ultrasound guidance has resulted in improved consistency in radiation dose delivery to the entire prost ate. Early results are encouraging in terms of the relatively low morb idity of the procedure, improved local control rates, and biochemical progression free survival. This has resulted in an outpatient treatmen t that has high patient acceptance. (C) 1997 Wiley-Liss, Inc.