Emily Flower
Crown Princess Mary Cancer Centre; Institute of Medical Physics, University of Sydney
Senior Radiation Oncology Medical Physicist

Kathy Tran
Radiation Therapist
Crown Princess Mary Cancer Centre

Salman Zanjani
Radiation Therapist
Crown Princess Mary Cancer Centre

Alicja Wach
Radiation Oncology Medical Physicist
Crown Princess Mary Cancer Centre

Wayne Smith
Radiation Therapist
Crown Princess Mary Cancer Centre

Jonathan Karpelowsky
Surgical Oncologist
The Childrens Hospital at Westmead

Angus Alexander
Paediatric Urologist
The Childrens Hospital at Westmead

Joseph Bucci
Radiation Oncologist
St George Hospital

Jennifer Chard
Radiation Onoclogist
Crown Princess Mary Cancer Centre

Background and Purpose: An 11 month old infant was treated with high dose rate brachytherapy alone for tumour management, following chemotherapy for a prostate/bladder embryonal rhabdomyosarcoma.

Methods:Pre-plans were completed on post chemotherapy imaging to ensure a brachytherapy approach was appropriate. Cystoscopy at the time of implant confirmed no macroscopic disease in the bladder itself and a small volume disease in the bladder neck. A combination trans-perineal and and trans-abdominal interstitial implant was achieved with trans-rectal ultrasound guidance and a direct surgical view. The ureters were transposed and reimplanted to avoid the high dose region. Daily CT imaging was used to confirm that the needle placement was correct.

Results: High dose rate brachytherapy was used to deliver a dose of 32.5 Gy to D98, with an EQD2 of 45 Gy. Organs at risk, including the rectum, bones, urethra, ureters and uninvolved bladder received acceptable doses.

Conclusions: A safe delivery of a fractionated, peri-operative high dose rate brachytherapy was achieved, with acceptable dosimetry dosimetry to both the clinical target volume and organs at risk. This involved co-operation across three different hospitals and a multi-disciplinary team.


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