Freiburg Flap Applicator

Brachytherapy comes from the Greek term brachy, translating to short distance and
can be used effectively as an intracavitary, interstitial or surface application in the treatment of
many cancers.1 The use of brachytherapy sources are preferred by many practitioners because of
their ability to deliver high dose to the tumor site while allowing for an abrupt dose drop off to
the surrounding normal structures. High dose rate (HDR) brachytherapy can be effectively
utilized in the treatment of various skin cancers and lesions with implantation by a Freiburg flap
applicator. This applicator is a flexible, surface applicator that is made of silicone rubber.
The Freiburg flap applicator most often uses Ir-192 sources that are easily exposed to the
superficial tumors or lesions through brachytherapy applicator cables.2,3 These cables pass
through 1 cm beads within the applicator and remain 0.5 cm off the patients skin (Figures 1 and
2). Through the use of an HDR after-loader, the sources can give the exposure to the treatment
site in a non-invasive manner while minimizing exposure to the practitioners involved in the
procedure (oral communication, B. Lemieux CMD July 2017). This easily adaptable material
allows the for the Freiburg flap applicator to be customized to each patients tumor or lesion.
The applicator is typically cut to fit the treatment area with 2 cm of applicator material beyond
the treatment area in all directions.3
Due to the easily conformable structure of the Freiburg Flap applicator material it can be
utilized in the treatment of many bodily areas such as the head, legs or chest. These areas often
exhibit a high degree of curvature which create difficulties or uncertainties with electron or
superficial photon treatments. Advantages in the treatment planning for the Freiburg flap vs.
electron beam are clearly demonstrated in Figure 3 showing a superficial chest treatment. This
comparison clearly shows a greater dose conformality with the Freiburg flap and significantly
higher skin dose achieved with 145% of the prescription dose as compared to 100% prescription
dose with the electron plan. In addition, HDR treatment of Ir-192 to these superficial areas will
offer a steeper fall off compared to superficial photon treatments.
References
1. Lenards N, Schmidt K, Berner P. Brachytherapy implants Introduction. [Softchalk]. La
Crosse, WI: UW-L Medical Dosimetry Program; 2016.
2. Dou K, Li B, Laser B, Jacobs M, Lerma F, Sarfaraz M. High dose rate Freiburg flap
applicator for skin lesion treatment: Alternative to electron or photon? MedStar Health
RadAmerica Mercy Medical Center Radiation Oncology. http://macaapm.org/fall2014/wp-
content/uploads/sites/5/2014/10/Session-3.2-Kai-Dou.pdf. Accessed July 23, 2017.
3. Kasper M. Surface brachytherapy for squamous and basal cell carcinoma of the skin.
BrachyNext: Working together to shape the future of brachytherapy.
http://www.aoic.net/elekta/elk1402archive/G201Kasper.pdf. Accessed July 23, 2017.
 Figures
Figure 1: Freiburg flap applicator attached to aquaplast mask for a head lesion2

Figure 2: Freiburg flap applicator attached to aquaplast mold for breast keloid treatment2
Figure 3: Comparison of HDR plan using a Freiburg flap applicator vs. electron beam treatment2