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Semin Radiat Oncol. 2020 Jan;30(1):94-106. doi: 10.1016/j.semradonc.2019.09.001.

Brachytherapy Future Directions.

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Department of Radiation Oncology, University of California, San Francisco, CA. Electronic address:
Department of Radiation Oncology, University of Iowa, Iowa City, IA.
Department of Physics, Engineering Physics & Optics and Cancer Research Center, Université Laval, Quebec City, QC, Canada; Department of Radiation Oncology, Research Center of CHU de Québec, Université Laval, Quebec City, QC, Canada.
Department of Radiation Oncology, UT Southwestern, Dallas, TX.
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT.


Brachytherapy has advanced dramatically in the last decade due largely to improvements in applicators, imaging, treatment planning, and use of clinical trials. In addition, current research in brachytherapy technology continues to change how we deliver this treatment modality. The future of brachytherapy lies in the ability of new technologies to overcome real or perceived barriers. The focus for this manuscript is on specific tools that have or are near to being introduced in the clinic. First, we explore the impact electromagnetic tracking technologies can have on brachytherapy implants and planning workflow. This is followed by an overview of the use of 3D printing and its ability to help tailor brachytherapy implants. Next, we discuss advances in self-shielded applicators and intensity-modulated brachytherapy technology. The manuscript closes out with 2 sections on treatment planning. First is a discussion of biological optimization and its potential as compared with current techniques (eg, based on physical dosimetry). And lastly, a section on optimization treatment planning efficiencies in which we explore the potential for machine learning in brachytherapy. As recent clinical evidence continues to show excellent outcomes, this is an exciting time to practice brachytherapy. With the new technologies presented here, the future is even brighter.

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