Brachytherapy is the clinical use of radioactive isotopes to provide a highly conformal image-guided radiation therapy that takes advantage of the steep fall off dose characteristics and different energetic emanations to improve the therapeutic ratio. Historically it was the first mode of radiation therapy. The last 110 years has seen the full maturing of radiation oncology. Integral to this growth of radiation oncology has been the rise and fall of various types of brachytherapy, often in a reciprocal manner to the changes in external beam radiation therapy technology. Some early methods have endured to this day, including surface applications and some forms of gynecologic care. Prostate brachytherapy was practiced very early as intraurethral radium insertions, first for benign prostatic hypertrophy and then for prostate tumors. Modern prostate brachytherapy could not be farther away from this. Vascular brachytherapy has risen and fallen in a relatively short number of years, driven by huge financial pressure and eclipsed by innovative and disruptive technology, despite many randomized trials proving efficacy. Breast brachytherapy, once a part of boost therapy in the first wave of breast conservation a generation ago, is on the rise in intracavitary and interstitial forms of accelerated partial breast irradiation for early, stage breast conserving therapy.

 

The context for writing this textbook is that of a dedicated division of brachytherapy in a large urban teaching hospital with three core missions: excellence in clinical care of patients, excellence in teaching, and excellence in research. This textbook addresses all three goals. It is my hope that assembling the literature, describing techniques, and illustrating these with actual clinical examples will serve to update practitioners and students on the latest developments in brachytherapy for these disease sites, be a guide to clinical care, and in doing so will be a valuable teaching tool. At its heart, this textbook should be a practical source to clinical teams answering two basic questions, why and how. Ten clinical disease site chapters are preceded by chapters on practical radiobiology, practical physics considerations, and followed by a final chapter of organizational practical considerations. Chapters 3 to 12 on clinical disease sites flow generally in a cephalocaudal order. These vignette descriptions will help contextually orient the reader.