Table 1.
Potential fractionation options for gynecologic, breast, and prostate brachytherapy
| Disease site | Dose per fraction, Gy | Fx, # | EQD2 (+45 Gy EBRT, α/β = 10) | Author/Reference |
|---|---|---|---|---|
| Cervical Cancer | ||||
| Point A based | 8 | 3 | 80.3 | Souhami et al. (51) Phan et al. (62) Rao et al. (54) |
| 7 | 4 | 83.9 | ABS Consensus (63) ABS Task Group Report (50) |
|
| 6 | 5 | 84.3 | ||
| 5.5 | 5 | 79.8 | ||
| 5 | 6 | 81.8 | ||
| HDR interstitial (1 insertion) | 5–6 | 5 (BID) | 75–84 | |
| HDR interstitial (2 or 4 insertions) | 7 | 4 | 83.9 | |
| Uterine Cancer | ||||
| Vaginal cuff HDR monotherapy | 7 Gy at 0.5 cm | 3 | 57.8 (surface dose) | ABS Task Group Report (57) PORTEC-2 (16) |
| 5.5 Gy at 0.5 cm | 4 | 54.2 (surface dose) | ABS Task Group Report (50) | |
| 5 Gy at 0.5 cm | 5 | 58.9 (surface dose) | Jolly et al. (64) ABS Task Group Report (57) |
|
| 8.5 Gy at surface | 4 | 52.4 (surface dose) | MacLeod et al. (65) | |
| 6 Gy at surface | 5 | 40 (surface dose) | ABS Task Group Report (50) | |
| 4 Gy at surface | 6 | 28 (surface dose) | Townamchai et al. (66) | |
| Vaginal cuff HDR boost | 6 Gy at surface | 2 | 60.3 | RTOG 0921 (67) RTOG 0418 (68) ABS Task Group Report (57) |
| 6 Gy at surface | 3 | 68.3 | ||
| Inoperable Stage I HDR monotherapy |
8.5 Gy | 4 | 52.4 (no EBRT) | ABS Task Group Report (57) |
| 7.3 | 5 | 52.6 (no EBRT) | ||
| Inoperable Stage I HDR boost + EBRT |
8.5 | 2 | 70.5 | |
| Inoperable Sstage I HDR boost + EBRT |
6.5 | 3 | 71.1 | |
| Inoperable Stage I HDR boost + EBRT (50.4 Gy) |
6 | 2 | 65.6 | |
| Breast Cancer | ||||
| HDR accelerated partial breast irradiation | 3.4–4.0 | 8–10 (BID) | 42-45 (α/β = 4–5) | RTOG 9517 (58) Strnad et al. (59) |
| 7.5 | 3 | Khan et al. (69) | ||
| Prostate Cancer | ||||
| HDR monotherapy | 13.5 | 2 | 104.6 (α/β = 2) | Morton et al. (60) |
| LDR monotherapy | 1 | NCCN Prostate CPG (61) | ||
| I-125 | 145 | |||
| Pd-103 | 125 | |||
| Cs-131 | 115 | |||
| HDR boost (EBRT 37.5 Gy/15 fx) | 15 | 1 | 105.9 (α/β = 2) | Martell et al. (70) |
| HDR boost (EBRT 45–50.4 Gy) | 10.75 | 2 | ∼113 (α/β = 2) | NCCN Prostate CPG (61) |
| LDR boost | 1 | NCCN Prostate CPG (61) | ||
| I-125 | 110–115 | |||
| Pd-103 | 90–100 | |||
| Cs-131 | 85 | |||
ABS = the American Brachytherapy Society; LDR = low-dose-rate; EBRT = external beam radiation therapy; HDR = high-dose-rate.
Fractionation options are in alignment with ABS recommendations, and from published studies/series. Although multiple fractionation options exist, in the setting of COVID-19, priority should be given to shorter treatment courses (where appropriate) to minimize patient and health care worker exposure and resource utilization.