Intraoperative high-dose-rate brachytherapy: An American Brachytherapy Society consensus report.
This report presents recommendations from the American Brachytherapy Society for the use of intraoperative high-dose-rate (IOHDR) brachytherapy.



Members of the American Brachytherapy Society with expertise in IOHDR formulated this document based on their clinical experience and a review of the literature. This report covers the use of IOHDR in colorectal cancer, soft tissue sarcoma, gynecologic cancers, head and neck cancers, and pediatric cancers. This report does not cover intraoperative brachytherapy for breast cancer. Details about treatment planning and delivery are emphasized so this document can serve as a guide to practices implementing this technique.



IOHDR brachytherapy is generally most beneficial for patients with either close or positive margins and/or recurrent disease in a previous resection bed or previously irradiated area. IOHDR brachytherapy requires a well-coordinated multidisciplinary team. IOHDR brachytherapy is recommended in the treatment of both recurrent and primary locally advanced disease for colorectal and gynecologic malignancies, soft tissue sarcoma, and selected head and neck and pediatric malignancies. Other techniques such as perioperative fractionated brachytherapy are also acceptable in many cases with some advantages and disadvantages compared to IOHDR.



IOHDR brachytherapy is a specialized technique in radiation therapy with unique properties and advantages in cancer control. Special considerations for treatment planning and delivery are outlined herein.
Huntsman Cancer Institute, Department of Radiation Oncology, University of Utah, Salt Lake City, UT.
S
S
Lloyd
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY.
K M
KM
Alektiar
Department of Radiation Oncology, Northern California Kaiser Permanente, Santa Clara, CA.
S
S
Nag
Huntsman Cancer Institute, Department of Radiation Oncology, University of Utah, Salt Lake City, UT.
Y J
YJ
Huang
Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
C L
CL
Deufel
Department of Radiation Physics-Patient Care, The University of Texas MD Anderson Cancer Center, Houston, TX; Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE.
F
F
Mourtada
Huntsman Cancer Institute, Department of Radiation Oncology, University of Utah, Salt Lake City, UT. Electronic address: david.gaffney@hci.utah.edu.
D K
DK
Gaffney
D001918:Brachytherapy / Q000379:methods*; D002648:Child; D015179:Colorectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy* / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012509:Sarcoma / Q000532:radiotherapy* / Q000601:surgery; D014481:United States
Colorectal cancer; Gynecologic cancer; Head and neck cancer; Intraoperative high-dose-rate brachytherapy; Pediatric cancer; Radiation planning; Sarcoma