Pulsed dose rate brachytherapy – is it the right way?

Pulsed dose rate (PDR-BT) treatment is a brachytherapy modality that combines physical advantages of high-dose-rate (HDR-BT) technology (isodose optimization, radiation safety) with the radiobiological advantages of low-dose-rate (LDR-BT) brachytherapy. Pulsed brachytherapy consists of using stronger radiation source than for LDR-BT and producing series of short exposures of 10 to 30 minutes in every hour to approximately the same total dose in the same overall time as with the LDR-BT. Modern afterloading equipment offers certain advantages over interstitial or intracavitary insertion of separate needles, tubes, seeds or wires. Isodose volumes in tissues can be created flexibly by a combination of careful placement of the catheter and the adjustment of the dwell times of the computerized stepping source. Automatic removal of the radiation sources into a shielded safe eliminates radiation exposures to staff and visitors. Radiation exposure is also eliminated to the staff who formerly loaded and unloaded multiplicity of radioactive sources into the catheters, ovoids, tubes etc. This review based on summarized clinical investigations, analyses the feasibility and the background to introduce this brachytherapy technique and chosen clinical applications of PDR-BT.