Radiation Oncology, Chulolongkorn University : High Dose Rate (HDR) Brachytherapy

Radiation Oncology Chulolongkorn University

High Dose Rate (HDR) Brachytherapy

à¹×èÍ§¨Ò¡¨Ó¹Ç¹¼Ùé»èÇÂÁÐàÃç§»Ò¡Á´ÅÙ¡·ÕèÊÒ¢ÒÃÑ§ÊÕÃÑ¡ÉÒ âÃ§¾ÂÒºÒÅ¨ØÌÒÅ§¡Ã³ì ÁÕ¨Ó¹Ç¹à¾ÔèÁÁÒ¡¢Öé¹
·Ø¡»Õ ´Ñ§Ê¶ÔµÔ·Õèä´éáÊ´§äÇéáÅéÇ ·ÓãËéÁÕ»ÑËÒã¹´éÒ¹¡ÒÃãËéºÃÔ¡ÒÃá¡è¼Ùé»èÇÂ â´Âà©¾ÒÐ¨Ó¹Ç¹àµÕÂ§·Õè¨ÐµéÍ§
ÃÑº¼Ùé»èÇÂäÇéã¹âÃ§¾ÂÒºÒÅà¾×èÍÃÑº¡ÒÃãÊèáÃè µÅÍ´¨¹¨Ó¹Ç¹¢Í§à¤Ã×èÍ§Á×ÍãÊèáÃè·ÕèÁÕ¨Ó¹Ç¹¨Ó¡Ñ´ ÁÕ¼Å·ÓãËé
¼Ùé»èÇÂºÒ§ÃÒÂäÁèä´éÃÑº¡ÒÃÃÑ¡ÉÒã¹ªèÇ§ÃÐÂÐàÇÅÒ·ÕèàËÁÒÐÊÁ
´Ñ§¹Ñé¹ã¹à´×Í¹¾ÄÉÀÒ¤Á ¾.È. 2538 ÊÒ¢ÒÃÑ§ÊÕÃÑ¡ÉÒ ¢Í§âÃ§¾ÂÒºÒÅ¨ØÌÒÅ§¡Ã³ì ¨Ö§ä´éÁÕ¡ÒÃ¹Ó
à¤Ã×èÍ§ Microselectron «Öè§à»ç¹ÇÔ¸Õ¡ÒÃãÊèáÃèáºº high dose rate (HDR) áÅÐà»ç¹ remote control after
loading brachytherapy «Öè§ãªéáÃèÍÔÃÔà´ÕÂÁ - 192 (Iridium-192) à»ç¹áËÅè§¾ÅÑ§§Ò¹ÃÑ§ÊÕã¹¡ÒÃãÊèáÃèá¡è¼Ùé»èÇÂ
â´ÂÁÕ¢éÍ´ÕáÅÐ¢éÍàÊÕÂàÁ×èÍà·ÕÂº¡Ñº low dose rate ´Ñ§¹Õé¤×Í59,60

¢éÍ´Õ¢Í§ High dose rate (remote control afterloading)
1. ´éÒ¹¼Ùé»èÇÂ
- ÃÐÂÐàÇÅÒã¹¡ÒÃÃÑ¡ÉÒÊÑé¹ (àÇÅÒà»ç¹¹Ò·Õ) äÁè¨Óà»ç¹µéÍ§¹Í¹¾Ñ¡ã¹âÃ§¾ÂÒºÒÅ
à»ç¹¡ÒÃÃÑ¡ÉÒáºº¼Ùé»èÇÂ¹Í¡
- ÃÑ¡ÉÒ¼Ùé»èÇÂä´éËÅÒÂÃÒÂµèÍÇÑ¹
- Å´ÀÒÇÐá·Ã¡«éÍ¹·Õèà¡Ô´¢Öé¹¨Ò¡¡ÒÃ¹Í¹¹Ò¹ æ ã¹¼Ùé»èÇÂºÒ§ÃÒÂ«Öè§ÁÕâÃ¤ÍÂèÒ§Í×è¹ÃèÇÁ´éÇÂ
àªè¹ pulmonary emboli
2. ´éÒ¹ºØ¤¤ÅÒ¡Ã·Ò§¡ÒÃá¾·Âì
- äÁèµéÍ§àÊÕèÂ§µèÍ radiation hazard à¹×èÍ§¨Ò¡à»ç¹ remote control afterloading »éÍ§¡Ñ¹ÍÑ¹µÃÒÂ¨Ò¡ÃÑ§ÊÕ 100%
- äÁèµéÍ§ÁÕ¾ÂÒºÒÅ´ÙáÅà»ç¹¾ÔàÈÉ à¹×èÍ§¨Ò¡ªèÇ§àÇÅÒ¡ÒÃÃÑ¡ÉÒÊÑé¹ÁÒ¡
3. ´éÒ¹¿ÔÊÔ¡Êì (Physics)
- ÃÐËÇèÒ§¡ÒÃÃÑ¡ÉÒ µÓáË¹è§¢Í§ source, à¤Ã×èÍ§Á×Í¤èÍ¹¢éÒ§¤§·Õè à¹×èÍ§¨Ò¡ÃÐÂÐàÇÅÒã¹¡ÒÃÃÑ¡ÉÒÊÑé¹´Ñ§¡ÅèÒÇ áÅÐÁÕà¤Ã×èÍ§Á×Í·ÕèãªéÂÖ´»ÃÑºãËéà¤Ã×èÍ§Á×ÍÍÂÙè¤§·Õè ¼Ùé»èÇÂÊÒÁÒÃ¶¹Í¹¹Ôè§ä´é´Õ ·ÓãËé¡ÒÃ¤Ó¹Ç³»ÃÔÁÒ³ÃÑ§ÊÕ
·ÕèµÓáË¹è§µèÒ§ æ ¶Ù¡µéÍ§
- äÁèÁÕ»ÑËÒ·Ò§´éÒ¹ radiation protection à¾ÃÒÐà»ç¹ remote control
- ãªé computer planning system ·ÓãËéÁÕ radiation dosimetry ·ÕèáÁè¹ÂÓ
¢éÍàÊÕÂà»ÃÕÂº¢Í§ High dose rate
1. à¾ÔèÁ§Ò¹á¡èºØ¤¤ÅÒ¡Ã·Ñé§¹Ñ¡¿ÔÊÔ¡Êì ÃÑ§ÊÕÃÑ¡ÉÒá¾·Âì ¾ÂÒºÒÅ à¹×èÍ§¨Ò¡µéÍ§à¾ÔèÁ¨Ó¹Ç¹¤ÃÑé§
¢Í§¡ÒÃãÊèáÃè ÍÂèÒ§¹éÍÂ 3-4 fraction ¢Öé¹ä»
2. ÂÑ§äÁèÁÕÁÒµÃÒ°Ò¹¢Í§¡ÒÃÃÑ¡ÉÒÇèÒ»ÃÔÁÒ³ÃÑ§ÊÕ·Ñé§¨Ò¡¡ÒÃ©ÒÂÃÑ§ÊÕ¨Ò¡ÀÒÂ¹Í¡ áÅÐ¡ÒÃãÊèáÃè
¤ÇÃ¨Ðà»ç¹»ÃÔÁÒ³ÃÑ§ÊÕ¨Ó¹Ç¹à·èÒã´
3. ¼Å¢Í§¡ÒÃÃÑ¡ÉÒ·Ñé§ control rate áÅÐ¼Åá·Ã¡«éÍ¹ÂÑ§·ÃÒºäÁèá¹èªÑ´àËÁ×Í¹ low dose rate
4. à¹×èÍ§¨Ò¡ dose rage ÊÙ§ÁÒ¡ (> 12 Gy/hr) ¨Ö§µéÍ§ÃÐÇÑ§¢éÍ¼Ô´¾ÅÒ´µèÒ§ æ â´Âà©¾ÒÐ
¡ÒÃÇÒ§á¼¹¡ÒÃÃÑ¡ÉÒáÅÐ¤Ó¹Ç³»ÃÔÁÒ³ÃÑ§ÊÕ µéÍ§¡ÒÃ¤ÇÒÁÅÐàÍÕÂ´¶Ù¡µéÍ§ÁÒ¡¡ÇèÒ low dose rate áÅÐ
ãªéà¤Ã×èÍ§¤ÍÁ¾ÔÇàµÍÃìã¹¡ÒÃ¤Ó¹Ç³
5. à¤Ã×èÍ§Á×ÍÁÕÃÒ¤Òá¾§
6. ¡Ã³Õãªé Co-60 áÅÐ Ir-192 à»ç¹ source «Öè§ half-life ÊÑé¹ (5 »Õ áÅÐ 74 ÇÑ¹ µÒÁÅÓ´Ñº)
¨Ö§à»Å×Í§§º»ÃÐÁÒ³ã¹¡ÒÃà»ÅÕèÂ¹ source ãËÁè
7. ¡ÒÃºÓÃØ§ÃÑ¡ÉÒà¤Ã×èÍ§Á×ÍÂØè§ÂÒ¡ µéÍ§ãªé§º»ÃÐÁÒ³áÅÐºØ¤¤ÅÒ¡Ãà©¾ÒÐ·Ò§ µÃÇ¨ÊÍº
¤ÇÒÁ¶Ù¡µéÍ§¢Í§¤ÍÁ¾ÔÇàµÍÃì ºØ¤¤ÅÒ¡Ã·ÕèÊÓ¤Ñ¡ç¤×Í¹Ñ¡¿ÔÊÔ¡Êì

¢éÍä´éà»ÃÕÂº¢Í§ Low dose rate
1. à¹×èÍ§¨Ò¡à»ç¹ÇÔ¸Õ¡ÒÃ·ÕèãªéÃÑ¡ÉÒÁÒ¹Ò¹áÅéÇ ¨Ö§·ÃÒº¼Å¢Í§ÃÑ§ÊÕáÅÐ»ÃÔÁÒ³ÃÑ§ÊÕ·Õèãªé¡Ñ¹ÍÂèÒ§
á¹è¹Í¹à»ç¹ÁÒµÃÒ°Ò¹
2. ·Ò§´éÒ¹¡ÒÃÇÒ§á¼¹¡ÒÃÃÑ¡ÉÒ·Ò§¿ÔÊÔ¡Êì äÁèÂØè§ÂÒ¡àËÁ×Í¹ high dose rate äÁèµéÍ§ãªé
ºØ¤¤ÅÒ¡Ã¾ÔàÈÉ
3. ¶éÒ source ·Õèãªéà»ç¹ radium -226 ¡çãªéä´éµÅÍ´äÁèµéÍ§à»ÅÕèÂ¹ source ãËÁè à¾ÃÒÐÁÕ half-life
¹Ò¹ 1,620 »Õ áÅÐ¶éÒ source à»ç¹ Cesium-137 (half-life 30 »Õ) ¡çà»ÅÕèÂ¹ source ªéÒ¡ÇèÒÁÒ¡
4. äÁèµéÍ§¤Ó¹Ç³ dose rate ãËÁèºèÍÂ æ

¢éÍàÊÕÂà»ÃÕÂº¢Í§ Low dose rate
1. ¼Ùé»èÇÂµéÍ§¹Í¹ã¹âÃ§¾ÂÒºÒÅ à¹×èÍ§¨Ò¡¡ÒÃãÊèáÃèáµèÅÐ¤ÃÑé§ãªéàÇÅÒ 48-72 ªÑèÇâÁ§
2. µéÍ§¡ÒÃ¾ÂÒºÒÅ´ÙáÅã¹ËÍ¼Ùé»èÇÂÍÂèÒ§ã¡ÅéªÔ´
3. µéÍ§¡ÒÃËÍ¼Ùé»èÇÂ¾ÔàÈÉà¾×èÍ¡ÒÃ»éÍ§¡Ñ¹ÃÑ§ÊÕ
4. ÁÕ¢éÍ¨Ó¡Ñ´ã¹àÃ×èÍ§¨Ó¹Ç¹àµÕÂ§¼Ùé»èÇÂ
5. ´éÒ¹ dosimetry äÁèá¹è¹Í¹ à¾ÃÒÐÍÒ¨ÁÕ¡ÒÃ¢ÂÑºà¢Â×éÍ¹¢Í§¼Ùé»èÇÂ¢³ÐãËé¡ÒÃÃÑ¡ÉÒ ·ÓãËé
à¤Ã×èÍ§Á×ÍãÊèáÃèàÅ×èÍ¹ÍÍ¡ÁÒ¨Ò¡µÓáË¹è§»¡µÔä´é
¨ÐàËç¹ÇèÒ High dose rate brachytherapy ÁÕ¢éÍä´éà»ÃÕÂºµèÍ low dose rate brachytherapy
ËÅÒÂ»ÃÐ¡ÒÃ ´Ñ§¹Ñé¹ã¹»Ñ¨¨ØºÑ¹¹Õé ¨Ö§ÁÕ¡ÒÃ¾Ñ²¹Òà·¤¹Ô¤µèÒ§ æ ¢Í§ HDR ã¹ËÅÒÂ æ Ê¶ÒºÑ¹ãËéÁÕ
»ÃÐÊÔ·¸ÔÀÒ¾ÁÒ¡·ÕèÊØ´
ÊÒ¢ÒÃÑ§ÊÕÃÑ¡ÉÒ ÀÒ¤ÇÔªÒÃÑ§ÊÕÇÔ·ÂÒ ¤³Ðá¾·ÂÈÒÊµÃì ¨ØÌÒÅ§¡Ã³ìÁËÒÇÔ·ÂÒÅÑÂ ä´éÇÒ§¹âÂºÒÂ
¡ÒÃÃÑ¡ÉÒ¼Ùé»èÇÂÁÐàÃç§»Ò¡Á´ÅÙ¡ â´Â¡ÒÃãªé HDR à·ÕÂº¡Ñº LDR brachytherapy ´Ñ§¹Õé ¤×Í µÒÃÒ§·Õè 8

µÒÃÒ§·Õè 8 ¹âÂºÒÂ¡ÒÃÃÑ¡ÉÒ¼Ùé»èÇÂÁÐàÃç§»Ò¡Á´ÅÙ¡´éÇÂ HDR VS LDR brachytherapy

Whole pelvic XRT (Gy)	Brachytherapy	ERD3	ERD10
40 Gy	Ra 48 hr x 2F	153.40	101.60
	Cs 1750cGy x 2F	166.73	90.51
	Ir 7.5 Gy x 3F	145.40	87.40
50 Gy	Ra 72 hr x 1F	148.10	100.20
	Cs 2500cGy x 1F	156.93	90.29
	Ir 7.5 Gy x 2F	145.60	90.40

ERD3 (57,61,62) = Extrapolated response dose ¢Í§ late responding tissue
ERD10 (57,61,62) = Extrapolated response dose ¢Í§ early responding tussue
â´Â Late responding tissue ã¹·Õè¹ÕéËÁÒÂ¶Ö§ connective tissue ¢Í§ bladder, rectum áÅÐ ureter
Early responding tissue ËÁÒÂ¶Ö§ epithelial lining ËÃ×Í mucosa ¢Í§ bladder áÅÐ rectum ÃÇÁµÅÍ´¶Ö§
µÑÇà¹×éÍÁÐàÃç§àÍ§

¨ÐàËç¹ÇèÒ á¹Ç¹âÂºÒÂ¢Í§¡ÒÃãªé HDR brachytherapy ã¹¡ÒÃÃÑ¡ÉÒÁÐàÃç§»Ò¡Á´ÅÙ¡¹Ñé¹ ¾ÂÒÂÒÁ
ãËéÊÒÁÒÃ¶¤Çº¤ØÁâÃ¤à©¾ÒÐ·ÕèãËéÁÒ¡·ÕèÊØ´ áÅÐ»éÍ§¡Ñ¹ãËéà¡Ô´ÀÒÇÐá·Ã¡«éÍ¹¨Ò¡¡ÒÃÃÑ¡ÉÒãËé¹éÍÂ·ÕèÊØ´
ÍÂèÒ§äÃ¡çµÒÁ¶Ö§áÁé¡ÒÃãªé HDR brachytherapy ¨ÐÁÕ¢éÍ´ÕËÅÒÂÍÂèÒ§´Ñ§·Õè¡ÅèÒÇáÅéÇ¡çµÒÁ áµèã¹
»Ñ¨¨ØºÑ¹¹Õé¡çÂÑ§äÁè·ÃÒº»ÃÔÁÒ³ÃÑ§ÊÕ ÃÐÂÐàÇÅÒ áÅÐà·¤¹Ô¤»ÅÕ¡ÂèÍÂµèÒ§ æ ·ÕèàËÁÒÐÊÁ·ÕèÊØ´ à¾×èÍãªéà»ç¹
ÁÒµÃÒ°Ò¹ ¨Ö§¨Óà»ç¹·Õè¨ÐµéÍ§ÁÕ¡ÒÃÈÖ¡ÉÒáÅÐµÔ´µÒÁ¼Å¡ÒÃÃÑ¡ÉÒ¢Í§¼Ùé»èÇÂÍÂèÒ§µèÍà¹×èÍ§áÅÐã¡ÅéªÔ´µèÍä»
ÊèÇ¹à·¤¹Ô¤áÅÐ¢Ñé¹µÍ¹¡ÒÃãÊèáÃè microselectron áºº HDR brachytherapy ¹Ñé¹ àËÁ×Í¹¡Ñº·Õèãªéã¹
LDR brachytherapy ·Ø¡»ÃÐ¡ÒÃ à¾ÕÂ§áµèäÁè¨Óà»ç¹µéÍ§ÇÒ§ÂÒÊÅºãËé¼Ùé»èÇÂ à¹×èÍ§¨Ò¡à¤Ã×èÍ§Á×Í·ÕèãªéÊÓËÃÑº
¡ÒÃãÊèáÃèÁÕ¢¹Ò´àÅç¡ÁÒ¡ (àÊé¹¼èÒÈÙ¹Âì¡ÅÒ§¢Í§ central tube ÁÕ¢¹Ò´à¾ÕÂ§ 3.2 ÁÔÅÅÔàÁµÃ) ÊÒÁÒÃ¶ãÊèà¢éÒä»
ã¹â¾Ã§Á´ÅÙ¡ä´éâ´ÂäÁè¨Óà»ç¹µéÍ§·Ó¡ÒÃ¢ÂÒÂ»Ò¡Á´ÅÙ¡ ´Ñ§¹Ñé¹¼Ùé»èÇÂá·º¨ÐäÁèÁÕÍÒ¡ÒÃ»Ç´¨Ò¡¡ÒÃãÊèáÃè
àÁ×èÍ·Ó¡ÒÃÃÑ¡ÉÒàÊÃç¨¡ç¶Í´à¤Ã×èÍ§Á×ÍÍÍ¡¨Ò¡µÑÇ¼Ùé»èÇÂ áÅÐ¼Ùé»èÇÂ¡çÊÒÁÒÃ¶à´Ô¹·Ò§¡ÅÑººéÒ¹ä´é·Ñ¹·Õ

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Last modified on 25 October 1996