• Radiation Oncology Journal
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• v.16 no.4
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• pp.357-366
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• 1998

Brachytherapy is an essential part of radiotherapy for uterine cervical cancer. The low dose rate (LDR) regimen has been the major technique of intracavitary therapy for cervical cancer. However, there has been an expansion in the last 20 years of high dose rate (HDR) machines using Ir-192 sources. Since 1979, HDR brachytherapy has been used for the treatment of uterine cervical cancer in Korea. The number of institutions employing HDR has been increasing, while the number of low dose rate system has been constant. In 1995, there was a total 27 HDR brachytherapy units installed and 1258 cases of patients with cervical cancer were treated with HDR Most common regimens of HDR brachytherapy are total dose of 30-39 Gy at point A with 10-13 fractions in three fractions per week. 24-32 Gy with 6-8 fractions in two fractions per week, and 30-35 Gy with 6-7 fractions in two fractions per week. The average fractionation regimen of HDR brachytherapy is about 8 fractions of 4.1 Gy each to Point A. In Korea, treatment results for HDR brachytherapy are comparable with the LDR series and appears to be a safe and effective alternative to LDR therapy for the treatment of cervical carcinoma. Studies from the major centers report the five-year survival rate of cervical cancer as. 78-86$\%$ for Stage 1, 68-85$\%$ for stage 11, and 38-56$\%$ for Stage III. World-wide questionnaire study and Japanese questionnaire survey of multiple institutions showed no survival difference in any stages and dose-rate effect ratio (HDR/LDR) was calculated to be 0.54 to 0.58. However the optimum treatment doses and fractionation schemes appropriate to generate clinical results comparable to conventional LDR schemes have yet to be standardized. In conclusion, HDR intracavitary radiotherapy is increasingly practiced in Korea and an effective treatment modality for cervical cancer. To determine the optimum radiotherapy dose and fractionation schedule, a nation-wide prospective study is necessary in Korea. In addition, standardization of HDR application (clinical, computer algorithms, and dosimetric aspects) is necessary.

• The Journal of Korean Society for Radiation Therapy
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• v.10 no.1
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• pp.30-44
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• 1998

Accurate delivery of doses using a high dose rate(HDR) brachytherapy, remote afterloading system(RALS) depends on knowing the strength of the radioactive source at the time of treatment, the precision and consistency of the timer, and the ability of the unit to position the source at the proper dwell location along the applicator. Periodic Quality Assurance(QA) on HDR machines is a part of the standard protocol of any user. The safety of the patient & staff, positional accuracy, temporal accuracy, and dose delivery accuracy are periodically(weekly, quarterly, monthly) estimated using HDR source(Ir-192), treatment planning devices, measurement devices, and overall treatment devices with regard to treatment delivery. The overall measurement results are estimated successfully and assessed its clinical significance. As a result, our HDR brachytherapy units has been very accurate until now. The QA program protocol permits routine clinical use and provides a high confidence level in the accurate operation of HDR units. Therefore, regular QA of HDR brachytherapy is essential for successful treatment.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.5
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• pp.470-476
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• 2006

Low-dose rate brachytherapy(LDR) has been effective modality for treatment of oral cancer. But the disadvantage of LDR is radioexposure of medical staff. To overcome this problem, high dose rate(HDR) brachytherapy has been developed. Our study evaluates the outcomes of patients with tongue cancer as treated by HDR brachytherapy. Between 2002 and 2005, eight patients with carcinoma of the tongue were treated with HDR brachytherapy. Five patients had AJCC stage I or II disease and the remaining three patients had AJCC stage III or IV. The male-to-female ratio was 2:6 and the mean age was 60.1 years (range: 21-80 years).The median follow-up time was 23.8 months (range: 7-55 months). There was no local failure until now. Three patients showed some complications. Two patients showed soft tissue necrosis. There was no bone sequela in all cases. Our experience in treating tongue cancer with HDR brachytherapy is encouraging, because it gave a satisfactory local control. Prospective studies are necessary to delineate the optimum indication for this treatment modality and long-term outcome.

• Radiation Oncology Journal
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• v.9 no.2
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• pp.319-324
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• 1991

In our institution, a 76-year-old woman with primary urethral carcinoma was treated with remote afterloading high dose rate (HDR) interstitial brachytherapy using micro selectron Ir-192. In this paper, authors described the technical aspect of remote afterloading HDR interstitial brachytherapy for female urethal cancer.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.150-153
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• 2002

High dose rate (HDR) brachytherapy in the treatment of cervix carcinoma has become popular, because it eliminated many of the problems with conventional brachytherapy. In order to improve clinical effectiveness with HDR brachytherapy, dose calculation algorithm, optimization procedures, and image registrations should be verified by comparing the dose distributions from a planning computer and those from a humanoid phantom irradiated. Therefore, the humanoid phantom should be designed such that the dose distributions could be quantitatively evaluated by utilizing the dosimeters with high spatial resolution. Therefore, the small size of thermoluminescent dosimeter (TLD) chips with the dimension of 1/8" and film dosimetry with spatial resolution of <1mm used to measure the radiation dosages in the phantom. The humanoid phantom called a pelvic phantom is made of water and tissue-equivalent acrylic plates. In order to firmly hold the HDR applicators in the water phantom, the applicators are inserted into the grooves of the applicator supporters. The dose distributions around the applicators, such as Point A and B, can be measured by placing a series of TLD chips (TLD-to- TLD distance: 5mm) in three TLD holders, and placing three verification films in orthogonal planes.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.16
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• pp.7167-7170
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• 2015

Background: Although 3D image based brachytherapy is currently the standard of treatment in cervical cancer, most of the centres in developing countries still practice orthogonal intracavitary brachytherapy due to financial constraints. The quest for optimum dose and fractionation schedule in high dose rate (HDR) intracavitary brachytherapy (ICBT) is still ongoing. While the American Brachytherapy Society recommends four to eight fractions of each less than 7.5 Gy, there are some studies demonstrating similar efficacy and comparable toxicity with higher doses per fraction. Objective: To assess the treatment efficacy and late complications of HDR ICBT with 9 Gy per fraction in two fractions. Materials and Methods: This is a prospective institutional study in Southern India carried on from $1^{st}$ June 2012 to $31^{st}$ July 2014. In this period, 76 patients of cervical cancer satisfying our inclusion criteria were treated with concurrent chemo-radiation following ICBT with 9 Gy per fraction in two fractions, five to seven days apart. Results: The median follow-up period in the study was 24 months (range 10.6 - 31.2 months). The 2 year actuarial local control rate, disease-free survival and overall survival were 88.1%, 84.2% and 81.8% respectively. Although 38.2% patients suffered from late toxicity, only 3 patients had grade III late toxicity. Conclusions: In our experience, HDR brachytherapy with 9 Gy per fraction in two fractions is an effective dose fractionation for the treatment of cervical cancer with acceptable toxicity.

• Radiation Oncology Journal
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• v.20 no.3
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• pp.228-236
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• 2002

Purpose : Although high-dose-rate (HDR) brachytherapy regimens have been practiced with a variety of modalities and various degrees of success, few studies on the subject have been conducted. The purpose of this study was to compare the results of local control and late complication rate according to different HDR brachytherapy fractionation regimens in uterine cervical cancer patients. Methods and Materials : From November 1992 to March 1998, 224 patients with uterine conical cancer were treated with external beam irradiation and HDR brachytherapy. In external pelvic radiation therapy, the radiation dose was $45\~54\;Gy$ (median dose 54 Gy) with daily fraction size 1.8 Gy, five times per week. In HDR brachytherapy, 122 patients (Group A) were treated with three times weekly with 3 Gy to line-A (isodose line of 2 cm radius from source) and 102 patients (Group B) underwent the HDR brachytherapy twice weekly with 4 or 4.5 Gy to line-A after external beam irradiation. Iridium-192 was used as the source of HDR brachytherapy. Late complication was assessed from grade 1 to 5 using the RTOG morbidity grading system. Results : The local control rate (LCR) at 5 years was $80\%$ in group A and $84\%$ in group B (p=0.4523). In the patients treated with radiation therapy alone, LCR at 5 years was $60.9\%$ in group A and $76.9\%$ in group B (p=0.2557). In post-operative radiation therapy patients, LCR at 5 years was $92.6\%$ In group A and $91.6\%$ in group B (p=0.8867). The incidence of late complication was $18\%$ (22 patients) and $29.4\%$ (30 patients), of bladder complication was $9.8\%$ (12 patients) and $14.7\%$ (15 patients), and of rectal complication was $9.8\%$ (12 patients) and $21.6\%$ (22 patients), in group A and B, respectively. Lower fraction sized HDR brachytherapy was associated with decrease in late complication (p=0.0405) (rectal complication, p=0.0147; bladder complication, p=0.115). The same result was observed in postoperative radiation therapy patients (p=0.0860) and radiation only treated patients (0=0.0370). Conclusion : For radiation only treated patients, a greater number of itemized studies on the proper fraction size of HDR brachytherapy, with consideration for stages and prognostic factors, are required. In postoperative radiation therapy, the fraction size of HDR brachytherapy did not have much effect on local control, yet the incidence of late complication increased with the elevation in fraction size. We suggest that HDR brachytherapy three times weekly with 3 Gy could be an alternative method of therapy.

• Progress in Medical Physics
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• v.14 no.1
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• pp.15-19
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• 2003

High dose rate (HDR) brachytherapy for treating a cervix carcinoma has become popular, because it eliminates many of the problems associated with conventional brachytherapy. In order to improve the clinical effectiveness with HDR brachytherapy, a dose calculation algorithm, optimization procedures, and image registrations need to be verified by comparing the dose distributions from a planning computer and those from a phantom. In this study, the phantom was fabricated in order to verify the absolute doses and the relative dose distributions. The measured doses from the phantom were then compared with the treatment planning system for the dose verification. The phantom needs to be designed such that the dose distributions can be quantitatively evaluated by utilizing the dosimeters with a high spatial resolution. Therefore, the small size of the thermoluminescent dosimeter (TLD) chips with a dimension of <1/8"and film dosimetry with a spatial resolution of <1mm used to measure the radiation dosages in the phantom. The phantom called a pelvic phantom was made from water and the tissue-equivalent acrylic plates. In order to firmly hold the HDR applicators in the water phantom, the applicators were inserted into the grooves of the applicator holder. The dose distributions around the applicators, such as Point A and B, were measured by placing a series of TLD chips (TLD-to-TLD distance: 5mm) in the three TLD holders, and placing three verification films in the orthogonal planes. This study used a Nucletron Plato treatment planning system and a Microselectron Ir-192 source unit. The results showed good agreement between the treatment plan and measurement. The comparisons of the absolute dose showed agreement within $\pm$4.0 % of the dose at point A and B, and the bladder and rectum point. In addition, the relative dose distributions by film dosimetry and those calculated by the planning computer show good agreement. This pelvic phantom could be a useful to verify the dose calculation algorithm and the accuracy of the image localization algorithm in the high dose rate (HDR) planning computer. The dose verification with film dosimetry and TLD as quality assurance (QA) tools are currently being undertaken in the Catholic University, Seoul, Korea.

• Radiation Oncology Journal
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• v.20 no.4
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• pp.396-404
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• 2002

Purpose : Many papers support a correlation between rectal complications and rectal doses in uterine cervical cancer patients treated with radical radiotherapy. In vivo dosimetry in the rectum following the ICRU report 38 contributes to the quality assurance in HDR brachytherapy, especially in minimizing side effects. This study compares the rectal doses calculated in the radiation treatment planning system to that measured with a silicon diode the in vivo dosimetry system. Methods : Nine patients, with a uterine cervical carcinoma, treated with Iridium-192 high dose rate brachytherapy between June 2001 and Feb. 2002, were retrospectively analysed. Six to eight-fractions of high dose rate (HDR)-intracavitary radiotherapy (ICR) were delivered two times per week, with a total dose of $28\~32\;Gy$ to point A. In 44 applications, to the 9 patients, the measured rectal doses were analyzed and compared with the calculated rectal doses using the radiation treatment planning system. Using graphic approximation methods, in conjunction with localization radiographs, the expected dose values at the detector points of an intrarectal semiconductor dosimeter, were calculated. Results : There were significant differences between the calculated rectal doses, based on the simulation radiographs, and the calculated rectal doses, based on the radiographs in each fraction of the HDR ICR. Also, there were significant differences between the calculated and measured rectal doses based on the in-vivo diode dosimetry system. The rectal reference point on the anteroposterior line drawn through the lower end of the uterine sources, according to ICRU 38 report, received the maximum rectal doses in only 2 out of the nine patients $(22.2\%)$. Conclusion : In HDR ICR planning for conical cancer, optimization of the dose to the rectum by the computer-assisted planning system, using radiographs in simulation, is improper. This study showed that in vivo rectal dosimetry, using a diode detector during the HDR ICR, could have a useful role in quality control for HDR brachytherapy in cervical carcinomas. The importance of individual dosimeters for each HDR ICR is clear. In some departments that do not have the in vivo dosimetry system, the radiation oncologist has to find, from lateral fluoroscopic findings, the location of the rectal marker before each fractionated HDR brachytherapy, which is a necessary and important step of HDR brachytherapy for cervical cancer.

• Radiation Oncology Journal
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• v.32 no.4
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• pp.238-246
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• 2014

Purpose: To evaluate the clinical outcome of high-dose-rate (HDR) interstitial brachytherapy (IBT) in patients with oral cavity cancer. Materials and Methods: Sixteen patients with oral cavity cancer treated with HDR remote-control afterloading brachytherapy using $^{192}Ir$ between 2001 and 2013 were analyzed retrospectively. Brachytherapy was administered in 11 patients as the primary treatment and in five patients as salvage treatment for recurrence after the initial surgery. In 12 patients, external beam radiotherapy (50-55 Gy/25 fractions) was combined with IBT of 21 Gy/7 fractions. In addition, IBT was administered as the sole treatment in three patients with a total dose of 50 Gy/10 fractions and as postoperative adjuvant treatment in one patient with a total of 35 Gy/7 fractions. Results: The 5-year overall survival of the entire group was 70%. The actuarial local control rate after 3 years was 84%. All five recurrent cases after initial surgery were successfully salvaged using IBT ${\pm}$ external beam radiotherapy. Two patients developed local recurrence at 3 and 5 months, respectively, after IBT. The acute complications were acceptable (${\leq}grade$ 2). Three patients developed major late complications, such as radio-osteonecrosis, in which one patient was treated by conservative therapy and two required surgical intervention. Conclusion: HDR IBT for oral cavity cancer was effective and acceptable in diverse clinical settings, such as in the cases of primary or salvage treatment.