Early results and technical shortcomings in intravascular brachytherapy of coronary arteries: a radiotherapist's point of view

The introduction describes the problem of restenosis in coronary artery disease and the therapeutic options to prevent it In Part I of this thesis we evaluated clinical results. Chapter I describes the clinical results of patients treated in Rotterdam, who were included in the BERT triaL More extensive clinical data of patients entered in various trials and the different brachytherapy systems used at that time are presented in Chapter 2. Finally Chapter 3 gives the results of a large European registry, confirming the positive trial results in routine clinical practice. Part II focusses on the role of intravascular ultrasound (IVUS) in coronary brachytherapy, as a tool for dosimetry (Chapter 4) and as an imaging technique to help to understand the mechanisms of action of brachytherapy (Chapter 5). In Part III we looked deeper into the dosimetry of two very specific clinical situations. Because of a trend towards treating longer and more complex lesions we evaluated the accuracy of the manual multisegmental irradiation, performed in 33 patients included in the European registry (Chapter 6). In Chapter 7 the question "can a bifurcation be irradiated adequately and if so, how to do it?" was addressed. Part IV considers the late effects on different organs, the carcinogenic effects and a review of the literature of radiation induced coronary artery disease. To conclude the effectiveness of vascular brachytherapy is reviewed through the different trials, limiting factors are discussed, as well as alternative therapies.