33 Endovascular Brachytherapy

Endovascular Brachytherapy 661

Aneurysm formation has been associated with early coronary brachytherapy experience. It is not yet clear whether there is a definite correlation. If many patients with a benign disease are going to be treated with brachytherapy, the issue of induction of malignancy must be carefully considered and long term follow-up is needed. ----------------------------- Brachytherapy to prevent from restenosis after angioplasty has proved to be feasible and effective but it is still at an early stage. There are many issues to be resolved such as definition of the target volume, optimal dose and dose distribution and the most effective delivery method. Carefully designed and performed follow-up studies are needed for many years to determine the long term therapeutic benefit and adverse side effects of brachytherapy. 12 References 1. Böttcher HD, Schopohl B, Liermann D, et al. Endovascular irradiation-a new method to avoid recurrent stenosis after stent implantation in peripheral arteries: technique and preliminary results. Int J Radiat Oncol Biol Phys 1994; 29 : 183-6. 2. Kirisits C. Physical aspects of endovascular brachytherapy. Doctoral thesis, Technical University Vienna 2001. 3. Leon MB, Teirstein PS, Moses JW, et al. Localized intracoronary gamma-radiation therapy to inhibit the recurrence of restenosis after stenting. N Engl J Med 2001; 344 (4) : 250-6. 4. Nath R, Anderson L, Luxton G, et al. Dosimetry of interstitial brachytherapy sources, recommendations of the AAPM Radiation Therapy Committee Task Group No.43. Med Phys 1995; 22 (2) : 209-34. 5. Pötter R, Van Limbergen E, Dries W, et al. GEC ESTRO Recommendations for prescribing, recording, and reporting endovascular brachytherapy. Radiother Oncol 2001; 59 : 339-60. 6. Pokrajac B, Pötter R, Maca T, et al. Intra-arterial 192 Ir HDR brachytherapy for prophylaxis of restenosis after femoropopliteal percutaneous transluminal angioplasty: the prospective randomized Vienna-2 trial. Radiotherapy parameters and risk factors analysis. Int J Radiat Oncol Biol Phys 2000; 48 (4) : 923-31. 7. Popowski Y, Verin V, Urban P. Endovascular ß-irradiation after percutaneous transluminal coronary balloon angioplasty. Int J Radiat Oncol Biol Phys 1996; 36 : 841-45. 8. Schopohl B, Lierman D, Jülling-Pohlit L, et al. 192Ir endovascular brachytherapy for avoidance of intimal hyperplasia after percutaneous transluminal angioplasty and stent implantation in peripheral vessels. 6 years of experience. Int J Radiat Oncol Biol Phys 1996; 36 : 835-40. 9. Teirstein PS, Massullo V, Jani S, et al. Catheter-based radiotherapy to inhibit restenosis after coronary stenting. N Engl J Med 1997; 336 : 1697-703. 10. Teirstein PS, Massullo V, Jani S, et al. Three-year clinical and angiographic follow-up after intracoronary radiation: results of a randomized clinical trial. Circulation 2000; 101 (4) : 360-65. 11. Verin V, Urban P, Popowski Y, et al. Feasibility of intracoronary ß-irradiation to reduce restenosis after balloon angioplasty. A clinical pilot study. Circulation 1997; 95 : 1138-44. 12. Verin V, Popowski Y, Urban P, et al. Intra-arterial beta irradiation prevents neointimal hyperplasia in a hypercholesterolemic rabbit restenosis model. Circulation 1995; 92 : 2284-90. 13. Verin V, Popowski Y, de Bruyne B, et al. Endoluminal beta-Radiation Therapy for the Prevention of Coronary Restenosis after Balloon Angioplasty. N Engl J Med 2001; 344 (4) : 243-49. 14. Waksman R, Robinson KA, Crocker IR, et al. Endovascular low-dose irradiation inhibits neointima formation after coronary artery balloon injury in swine. A possible role for radiation therapy in restenosis prevention. Circulation 1995; 91 : 1533-39. 15. Waksman R (ed): Vascular Brachytherapy (2 nd edition) 1999; Futura Publishing, New York.