Brachytherapy

Brachytherapy, also known as internal radiation, treats tumors by placing a small source of radioactive material directly into the body. Brachytherapy can be used in many types of cancer throughout the body. The invasiveness of this procedure varies depending on the location of a tumor.

What is Brachytherapy?

Brachytherapy refers to multiple procedures that treat tumors by placing a small source of radioactive material directly into the body. These small sources of radiation can deliver higher total doses of radiation to the treatment area while minimizing damage to surrounding healthy tissue. Brachytherapy is also called internal radiation.

All types of radiation therapy work by damaging the DNA of cancerous cells, destroying their ability to grow and spread. Over time, tumors shrink or die altogether.

Applications of Brachytherapy. Image courtesy of Wikimedia Commons, Rock MC1 (creator).

Brachytherapy can treat many types of cancer, including:

• Breast cancer
• Gynecologic malignancies (HDR – High Dose Rate Brachytherapy)
• Prostate cancer (Prostate Seed Implants)
• Breast cancer
• Lung cancer

Brachytherapy is permanent or temporary, and can be used alone or in conjunction with other therapies such as surgery and external beam radiation. In general, brachytherapy is not as lengthy as some types of external beam radiation therapies.

Temporary brachytherapy: Radioactive material is placed into a thin tube, catheter, needle, or other type of applicator and inserted into the body for a set amount of time. After that time, the material is removed. Temporary brachytherapy may be administered at a Low Dose Rate (LDR) or High Dose Rate (HDR) depending on the size and type of tumor.

Permanent brachytherapy: Permanent brachytherapy, also known as seed implantation, places several radioactive ‘seeds’ into a tumor and leaves them there. These seeds are usually metallic and about the size of a grain of rice. The radioactivity of the seeds quickly diminishes. The inert seeds remain in the body with no adverse effects to the patient.

Your Radiation Oncologist Works With a Specialized Team to:

• Determine the correct mode and duration of therapy
• Where to apply treatment
• How much radiation is needed for the treatment
• Deliver the actual treatment
• Provide information and post-treatment care to patients

One of the greatest advantages of brachytherapy is that it works from the inside out. During external beam radiation therapy, beams of radiation must pass through normal tissue before reaching the tumor. While this exposure is minimal, brachytherapy further minimizes this additional exposure and concentrates the greatest dose where it is needed.

How is Brachytherapy Performed?

There are several ways that brachytherapy may be performed on a patient. The exact method used will depend on the specific treatment.

Your doctor will place the source of radiation into your body in one of two ways depending on the location of the tumor.

Intracavity brachytherapy: The radiation source is placed into a body opening such as a windpipe either manually or remotely by a computer-controlled machine.
Interstitial brachytherapy: The source of radiation is placed directly into the body tissue such as a breast or prostate. Specialized applicators, needles, catheters, and other devices may be used to place the radiation.

Radiation can be given as High Dose Rate (HDR), Low Dose Rate (LDR), or as a permanent placement.

What to Expect During High Dose Rate Brachytherapy:

• HDR is an outpatient procedure, so you do not need to be admitted to the hospital.
• HDR takes place in multiple sessions.
• During treatment, the radioactive material is placed into your body for a short amount of time.
• You will lie in a comfortable position in a separate room during treatment.
• Your radiation therapy team will ensure that the radiation device is in place for intracavity brachytherapy. For interstitial brachytherapy, they will insert the source of radiation into the device.
• Once the radiation device is in place, your radiation therapy team will leave the room. They will be in contact with you for the duration of the treatment.
• You should not feel any pain or discomfort during treatment.
• If you have any concerns or discomfort during treatment, let your radiation team know.
• You will not be radioactive following treatment, and can immediately resume normal interactions and activities.

What to Expect During Permanent Brachytherapy:

• Your team which includes your radiation oncologist, urologist, physicist, nurse, and medical dosimetrist will work together to perform real-time ultrasound-guided brachytherapy.
• SpaceOAR (Hydrogel) will be placed in the perirectal region to decrease dose to the rectum.
• The source of radiation is placed into the body and is not removed following treatment.
• The area which is being treated will be radioactive for a short time; however, the radiation quickly becomes inert.

Depending on the strength of the radiation, you may or may not have restrictions on contact with others.

Every patient is different. At Blue Ridge Radiation Oncology, our doctors tailor every treatment plan to each individual to ensure that you are getting the best quality care.

Side Effects of Brachytherapy

The side effects of brachytherapy are generally limited to the area which is being treated. Many patients experience tenderness, irritation, and swelling in the treatment area.

Short-Term Side Effects on the Skin:

• Redness
  Dry skin

Late-Term Side Effects on the Skin:

• Discoloration of skin or residual mark
• Hair loss at the treatment site

Common Side Effects in the Breast:

• Redness
• Breast pain or tenderness
• Infection
• Bruising
• Breakdown of fat tissue in the targeted area of the breast

Short-Term Side Effects in the Pelvic Area:

• Hair loss in pubic region
• Urination changes
• Diarrhea
• Skin inflammation or swelling
• Skin irritation

Late-Term Side Effects in the Pelvic Region:

• Infertility and early menopause in women
• Infertility in men
• Incontinence
• Skin changes

Your doctor will advise you of side effects specific for your treatment.