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Teri Burrier
Brachytherapy Discussion
July 2018
Freiberg Flap Applicator
Brachytherapy is a term used to describe the treatment of cancer using small,
encapsulated radionuclide sources within a short distance.1 These sources can be
permanent or temporary and are placed within or near the area to be treated. There are
many different locations that can be used for brachytherapy treatments including
intracavitary, interstitial, intraluminal, intravascular, and the skin surface. One applicator
used for surface and intraoperative brachytherapy in particular is the Freiberg Flap
applicator.
The Freiberg flap applicator is used for high-dose-rate (HDR) brachytherapy and
utilizes flexible, small, round spheres.2 The flexible design of the applicator is due to the
mesh that the silicone rubber spheres are attached to (Figure 1), which allows for multi-
planar flexibility.3 Each sphere has a separation of 5mm from the center of each sphere to
its edge and has a channel to allow for the insertion of flexible catheters that allow a
remote afterloader to place the Ir-192 sources that are commonly used with this
treatment.3 One advantage of this applicator over others is that it can be used to cover
large areas and, due to its flexible design, can conform to complex body contours that
may not be covered effectively with electrons.2 Figure 2 demonstrates the flexibility of
the Freiberg flap applicator in its treatment of Kaposi’s sarcoma on the top of a foot.
A drawback to using the Freiberg Flap applicator is the need to use thick boluses
with treatment to compensate for the lack of backscatter material on top of the applicator
and between the spheres.2 Furthermore, HDR planning is typically more labor intensive
compared to external beam therapy. Despite these drawbacks, the Freiberg applicator’s
ability to be customized to fit many different surface contours, as well as internal sites,
make it an ideal choice for high-dose-rate brachytherapy procedures.
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Figures

Figure 1. Freiberg Flap applicator mesh.2

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Figure 2. Freiberg Flap application on the skin of the foot for Kaposi’s sarcoma.2
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References

1. Lenards N., Schmidt K., Berner P. Brachytherapy Implants: Introduction.

[SoftChalk]. La Crosse, WI: UW-L Medical Dosimetry Program; 2018.
2. Park JM, Kim IH, Ye SJ, Kim K. Evaluation of treatment plans using various
treatment techniques for the radiotherapy of cutaneous Kaposi’s sarcoma
developed on the skin of feet. J Appl Clin Med Phys. 2014;15(6):173-187.
http://dx.doi.org/10.1120/jacmp.v15i6.4970
3. Flower E, Tran KN, Zanjani S, et al. Brachytherapy for recurrent Wilm’s tumor
using a reconstructed Freiburg flap. J Contemp Brachytherapy. 2016;8(5):429-
433. http://dx.doi.org/10.5114/jcb.2016.62962