The Leipzig Cone Brachytherapy Surface Applicator

Alyssa Olson
The Leipzig applicator is a surface applicator used in brachytherapy treatments.1 It was
first developed in 1987 by the Leipzig University in Germany with specific intentions to treat
superficial tumors. This applicator, often combined with an Ir-192 high dose-rate source, has
been used to treat various skin cancers, Kaposi sarcomas, lymphoma skin protrusions, the oral
cavity, and vaginal cuff.1,2 With the advancements in technology, the Leipzig applicator offered a
new alternative for superficial treatments over the use of orthovoltage treatment units.2 Lesions
best suited for this type of treatment have characteristics which include a smooth surface, a
superficial location, a target size of less than 2.5cm in diameter, and the ability to achieve flush
tissue-to-applicator contact.
The applicator design has a few important components: the cone, catheter, and an
optional plastic cap.2 The applicator cone itself is made of a mixture of tungsten and steel, which
provides shielding to external structures in addition to dose homogeneity to the underlying
lesion.1,2 The isodose distribution is conical in shape, and has a relatively sharp fall-off of dose
beyond 5 cm, making it ideal for treatment of superficial lesions (Figure 1). The cones are
available in varying diameters of 1-3 cm to accommodate different target sizes. In addition, as
shown in Figure 2, the Leipzig cone has two different catheter orientation options: vertical or
horizontal. In either design, the radioactive source is fed through a steel catheter and into the
center of the collimated cone. The source remains in the dwelling locationlocated
approximately 1.5 cm above the treatment surfacefor a designated amount of time as per
prescription requirements.1 The last component of the Leipzig applicator is the protective plastic
cap (Figure 3).

A 1 mm plastic cap is placed on the end of the conein between the tissue and

the coneto absorb electron contamination and reduce the skin surface dose.1,3
Typical fractionation schemes for this type of treatment vary. One study completed by
Ghaly and colleagues4 delivered a total of 40 Gy to the affected area, with 5 Gy per fraction,
twice weekly. The study reported excellent cosmetic and remission outcomeshighlighting the
benefits of shorter treatment time durations. Finally, because of the reduced number of fractions
required while achieving excellent treatment outcomes, this study proposed a better patient
compliance rate versus traditional external beam therapy.

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References:
1. Pedraza R, Rojas EL, Mitsoura E. Dosimetric characterization of

192

Ir source-Leipzig

applicators sets for surface cancer treatment with Monte Carlo code MCNP4C. Mex J
Biomed Eng. 2009; 30(1): 33-40. http://www.medigraphic.com/pdfs/inge/ib2009/ib091g.pdf. Accessed April 18, 2016.
2. Perez-Calatayud J, Granero D, Ballester F, et al. A dosimetric study of Leipzig applicators.
Int J Radiat Onc Biol Phys. 2005;62(2):579-584. doi:10.1016/j.ijrobp.2005.02.028
3. Niu H, Hsi WC, Chu JCH, Kirk MC, Kouwenhoven E. Dosimetric characteristics of the
Leipzig surface applicators used in the high dose rate brachy radiotherapy. Med Phys. 2004;
31(12): 3372-3377. doi:10.1118/1.1812609
4. Ghaly M, Zinkin H, Dannenberg M, et al. HDR brachytherapy with standardized surface
applicators in the treatment of skin lesions. Int J Radiat Onc Bio Phys. 2008; 72(1):
dio:http://dx.doi.org/10.1016/j.ijrobp.2008.06.1474

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Figures

Figure 1. A comparison of the isodose distribution using the 3 cm diameter cone (left) versus
the 1 cm diameter cone (right).2

Figure 2. Examples of the vertical (left) and horizontal (right)

Leipzig applicator cones.2

Figure 3. Structural design of the Leipzig cone applicator including

the tungsten cone housing, steel catheter and dwelling location, and
the protective plastic cap.3