Figure 2 The evolution of brachytherapy for prostate cancer

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Figure 2 The evolution of brachytherapy for prostate cancer Figure 2 | The evolution of brachytherapy for prostate cancer. a | The use of prostatic brachytherapy was first reported in 1911, when radium was administered temporarily via a urethral catheter14,15. In 1917, a transperineal implantation of radium was performed in New York16. During the 1920s, cohorts of patients were treated with radium brachytherapy in the USA. b | In the 1950s, low-dose-rate brachytherapy (LDR‑BT) was performed with 198Au (REF. 18), but by the 1970s 125I seeds were used for prostate cancer implants21. A remote afterloading system (RALS) was developed in the 1980s and used for high-dose-rate brachytherapy (HDR‑BT). With more advanced forms of external beam radiotherapy (EBRT) (for example, 3D conformal radiotherapy and then image-modulated radiotherapy)35, EBRT was combined with both forms of brachytherapy to deliver brachytherapy boost56. EBRT developed in parallel over the 1990s and 2000s to become increasingly hypofractionated75. In 2001, the development of the robotic arm linear accelerator (LINAC), which delivers stereotactic body radiation therapy (SBRT), led investigators to tout it as “virtual brachytherapy”, and they touted this treatment to be a superior and more advanced form of brachytherapy, as it could be performed without anaesthesia or needles entering the prostate75. As of 2016, no trials comparing the two technologies have been performed76, and the dosimetric distribution of HDR‑BT (FIG. 1b) is superior to any form of EBRT because X‑rays do not pass through the skin of the patient4. c | Trends in the use of brachytherapy compared with other modalities of therapy in the USA from 1998–2013 show that use has declined over the time period. Brachytherapy use reached a high around 2002, when 18% of patients received the therapy64. d | Trends in the use of brachytherapy across risk groups. The percentage of patients treated with brachytherapy alone by year from 2004 to 2009 stratified by National Comprehensive Cancer Network (NCCN) risk grouping (upper panel), and percentage of patients treated with brachytherapy boost by year from 2004 to 2009 stratified by NCCN risk grouping (lower panel)64. Permission obtained from John Wiley & Sons Inc © Martin, J. M. Cancer 120, 2114–2121 (2014). Permission obtained from John Wiley & Sons Inc © Martin, J. M. Cancer 120, 2114–2121 (2014). Zaorsky, N. G. et al. (2017) The evolution of brachytherapy for prostate cancer Nat. Rev. Urol. doi:10.1038/nrurol.2017.76