Brachytherapy Procedure
Overview
Brachytherapy, also known as internal radiation therapy, is a type of cancer treatment in which medical professionals place radioactive material inside the body, close to the cancer site. This approach differs from external radiation therapy, which uses a machine positioned outside the body to aim radiation beams at the tumor.
Key features of brachytherapy include:
- Delivers radiation directly to the tumor.
- Allows for higher doses in a smaller area.
- Reduces damage to surrounding healthy tissues.
- Can shorten the total treatment time.
| Type | Placement | Dose to Tumor | Effect on Other Tissues |
|---|---|---|---|
| Brachytherapy | Inside the body | Higher | Lower |
| External Radiation | Outside the body | Lower | Higher |
Brachytherapy is especially useful for treating cancers in organs such as the prostate, breast, and cervix.
Reasons for Brachytherapy
Brachytherapy provides high doses of radiation to cancer areas while limiting exposure to healthy tissue. Doctors often choose it because it can be very effective against specific cancers like prostate, cervical, and breast cancers.
The treatment works alone or can be combined with other therapies such as surgery or external beam radiation therapy (EBRT). Some cancers commonly treated with brachytherapy include:
- Prostate Cancer: Doctors frequently use brachytherapy because the radiation can be placed close to the prostate, affecting mainly the tumor.
- Gynecological Cancers: Physicians use it for cervical, endometrial, and vaginal cancers to target the reproductive organs with precision.
- Breast Cancer: After removing a tumor, doctors sometimes use brachytherapy to destroy any remaining cancer cells.
- Other Cancers: This includes cancers of the head and neck, esophagus, lung, rectum, skin, soft tissue, brain, and even the eye.
Doctors can deliver brachytherapy as the only therapy or after surgery to help reduce the risk of cancer returning. In some cases, they pair it with EBRT for better results.
Possible Complications
Brachytherapy may lead to certain side effects that mainly impact the area being treated. Since the radiation targets a small spot, most healthy tissue nearby is less likely to be affected. People may feel swelling or discomfort around the treatment site. Main side effects can include:
- Tenderness at the spot of treatment
- Swelling or mild pain
- Skin irritation
- Rarely, other tissues close by can be affected by gamma rays
How You Get Ready
Before treatment, a person usually meets with a radiation oncologist to discuss the plan. Doctors may use imaging tests like MRI, CT scans, or X-rays to help create a treatment plan. Often, an ultrasound helps guide the placement of therapy or monitor progress. Hormone therapy can also be considered for some cases.
What You Can Expect
When someone gets internal radiation, also known as brachytherapy, the care team places a small source of radiation close to the cancer. This radiation source can come in many forms, such as pellets, seeds, or wires. The team can deliver the treatment in a few different ways, depending on the cancer’s location and the type of brachytherapy chosen.
Types of Brachytherapy Placement
| Type | Where it Goes | Tools Used | Example Cancers |
|---|---|---|---|
| Intracavity | Inside body cavities | Tubes, cylinders, applicators | Cervix, vagina |
| Interstitial | In body tissues | Seeds, needles, wires, catheters, balloons | Prostate, breast |
Internal Radiation in Body Cavities
For certain cancers, the care team places the radioactive device inside a natural opening in the body. This is common for cancers in the cervix or windpipe. The radiation team might use a soft tube or a shaped device for the job. These devices fit the cavity where treatment is needed.
Imaging, like CT scans or ultrasound, helps doctors guide the device to the correct spot. Sometimes a machine helps with placement, but often a member of the care team does it by hand.
Internal Radiation in Body Tissues
If the goal is to place the radioactive material right into the tissue, doctors may use small seeds, wires, balloons, or needles. For example, when treating prostate cancer, doctors often implant permanent seeds about the size of a grain of rice. Healthy tissue around the cancer receives less radiation because the source is so close to the tumor.
Doctors use tools such as hollow needles or special tubes (called catheters) to place the seeds or pellets exactly where they need to be. Imaging scans help guide the placement to make sure the treatment targets the right area. Sometimes, doctors insert these tubes during surgery and add the radioactive substance afterward.
Differences in Temporary and Permanent Therapy
Brachytherapy can be temporary or permanent, and the experience is a bit different for each:
Temporary Internal Radiation (High-Dose-Rate or HDR): The care team places the radioactive source inside the body for a short time, which could be as little as a few minutes up to about 20 minutes per session. Sessions usually happen once or twice a day for several days.
Permanent Internal Radiation (Low-Dose-Rate or LDR): The team places small radioactive seeds (such as ones containing iodine-125 or other radioisotopes) in the body and leaves them there. Over time, the seeds give off radiation and lose their power as the material decays.
What Happens During a Typical Treatment
Temporary internal therapy, like HDR, usually takes place in a special room. Here’s what someone might expect:
- Getting Ready:
The patient lies in a certain position depending on where the cancer is.
The team might give local or general anesthesia to help with comfort.
- Placing the Device:
A tube, cylinder, or special needle is carefully placed in or near the cancer.
The team checks placement using imaging scans.
- Delivering the Radiation:
The care team uses a machine, sometimes called an afterloader, to put the radioactive source, such as iridium-192 or other radioisotopes, into the device.
The care team steps out of the room but can watch through a window and talk to the patient through an intercom.
Ending the Session:
Once the required radiation dose is delivered, the care team removes the radioactive material.
The device may be taken out right after the session or left in until the next one.
- After the Session:
There is no leftover radiation in the body after temporary treatments.
Patients can usually go home the same day and be around family, with no restrictions.
What if the Radioactive Seeds are Permanent
Permanent seed brachytherapy is most commonly used to treat prostate cancer. The medical team places the radioactive seeds under anesthesia, using imaging tools like ultrasound or CT scans to ensure accurate placement. After the procedure, the patient will not feel the seeds inside the body.
For a short period, the treated area gives off a mild amount of radiation. Doctors may advise temporary precautions around children or pregnant people, but these restrictions typically do not last long. As the radioisotope (such as iodine-125) naturally breaks down, the level of radiation decreases.
Important Details
- The patient does not feel pain from the radiation itself.
- Most people can return to normal activities quickly.
- It’s important to communicate with the care team about any discomfort or concerns.
Common Devices and Materials Used
- Radioactive seeds or pellets (often with iodine-125 or palladium-103).
- Temporary sources (sometimes using iridium-192).
- Catheters or applicators for delivering the radioactive material.
Possible Side Effects
- Mild discomfort during procedure.
- Soreness at the site.
- Occasionally, a little swelling or bruising.
Patients will be informed about what symptoms to watch for and when to call for help. Every experience can vary slightly depending on the type of cancer and the brachytherapy method used.
Outcomes
After brachytherapy, patients often have regular follow-up checks, which may include scans or physical exams. The type of follow-up depends on the location of the cancer. These exams and scans help doctors evaluate how well the treatment worked and decide if any further steps are needed.
