The brachytherapy program at Cleveland Clinic is large and varied in the range and complexity of the implants done. In March, 1995 the High Dose Rate (HDR) Remote Afterloading program was introduced and many patients have been treated with this system. Cleveland Clinic presently uses the Nucletron microSelectron HDR brachytherapy unit along with Nucletron's most recent computer aided treatment design system (Plato BPS). Based on a high performance Unix workstation, the system offers integrated graphics capabilities that greatly facilitate the selection of an optimum plan of treatment. In addition to intra-cavitary and intra-luminal treatments that are routinely done across the country using HDR brachytherapy afterloading techniques, many large volume template guided, and complex "freehand" implants have been performed at Cleveland Clinic in a large variety of sites throughout the body.
Sophisticated dose-volume/dose-rate conversions are used to convert decades of experience with low dose rate brachytherapy to give the equivalent doses for HDR brachytherapy treatments.
The enhanced nursing care possible with HDR brachytherapy treatment techniques compared to that of low dose rate treatment is appreciated by the patients. Short treatment times, fractionated between one to seven fractions leave the patients radiation free between HDR brachytherapy treatments enabling unrestricted nursing care and visitation with family and friends. Some forms of HDR brachytherapy treatment allow the patients to go home between treatment fractions, returning for their treatments (which take about a half-hour) as outpatients.
Despite the large range of HDR brachytherapy treatments already offered at the Cleveland Clinic, this number will increase with the introduction of the special-procedures suite planned for the near future. This HDR brachytherapy system will allow radiation oncologists and surgeons the opportunity to sterilize any remaining tumors in those surgical cases resulting in incomplete resection. Whether due to the extent or location of the disease, catheters can be placed around or through the HDR brachytherapy treatment area during surgery. The HDR brachytherapy treatment can then be given in a few minutes and the surgery can conclude in the usual manner. This new HDR brachytherapy treatment modality allows a treatment option for certain patients where sometimes no alternative exists.
The following are Cleveland Clinic Medical Physicists with a special interest in HDR brachytherapy treatments:
D. Allan Wilkinson, PhD
