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Understanding Radiation Brachytherapy

Sep 01, 2011

By Subir Nag, M.D.

What is meant by brachytherapy?

Radiation therapy to treat cancer is most commonly given from outside the patient's body (external beam radiation). An alternative way of giving radiation is by brachytherapy, in which the radiation is given directly to the tumor site by putting the radioactive material (in the form of seeds or pellets) inside or close to the tumor. In fact, the word brachytherapy comes from the Greek “brachy” meaning “short distance” and “therapia” meaning “treatment”. This direct treatment, also called a radiation implant, has the advantage of giving a high dose of radiation to the tumor in a very short time while very little radiation goes to healthy tissues around the tumor. Since the healthy tissues are not significantly affected, there are fewer side effects.

When Is Brachytherapy Useful

Brachytherapy can be used in most areas of the body. In small, localized tumors (e.g., prostate carcinoma), brachytherapy can be used alone. In more bulky tumors, Chemotherapy and/or external beam radiation is used to treat the lymph nodes and to shrink the tumor, and brachytherapy is used to increase the dose to the tumor. In tumors recurrent after external beam radiation, where other alternatives do not exist, brachytherapy can be given alone or combined with chemotherapy, or surgery. In cases in which a cure is not possible, brachytherapy can be used to shorten the duration of treatments and to offer some relief of suffering and pain.

Common sites implanted by brachytherapy include the cervix, endometrium, lung, prostate, breast, head and neck. Brachytherapy is less commonly used to treat tumors of the esophagus, eye, liver, brain, bladder, rectum, pancreas, or in children.

Brachytherapy Methods

Most implantations use a technique in which hollow tubes (catheters) or needles are placed in or around the tumor by the doctor, usually at the time of surgery. Radioactive pellets are put into these tubes or needles usually at a later time. Different types of brachytherapy can be used, depending upon the location of the implant and the duration of the treatment.

Interstitial Brachytherapy

Interstitial brachytherapy involves placing the radioactive material inside the tumor tissues. This form of brachytherapy is now commonly used to treat prostate cancer without requiring surgery or prolonged external beam radiation treatments while achieving good cure of the tumor.

Intracavitary Implants

Intracavitary techniques involve placing radioactive material into body cavities. This is especially useful in gynecological tumors where the radioactive material is placed in the uterine cavity and vagina.

Intraluminal Implants

In this type of implant, which is rarely used nowadays, the radioactive material is placed inside the lumen of the bronchial tubes, esophagus, bile duct or blood vessels.

Surface molds or plaques

In this technique, radioactive material in the form of molds or plaques is placed on the surface of the tumor rather than being placed inside the tumor. This method, though not very commonly used, is useful to treat eye tumors.

Systemic Brachytherapy

In this type of brachytherapy for patients with cancers that have spread to the bones, a liquid radioactive material (usually strontium) is injected into the arm veins to target the cancer-bearing areas. This single injection, done on an out-patient basis, is a convenient way to provide relief of bone pain from cancer. Some types of liver tumors can also be treated by injecting tiny radioactive spheres into the bloods vessels feeding the liver.

Removable Implants

Treatment with removable implants involves leaving radioactive material (iridium or cesium) in the cancerous tissues for two to seven days. To reduce radioactive exposure to others, patients with removable implants are housed in private rooms, and visiting time is restricted during the implantation. Lead shields are also used to limit exposure. Children and pregnant women may not visit patients with removable implants.

Permanent Implants

The permanent implant is a simpler procedure usually used for deep tumors. With this type of treatment, pellets containing radioactive iodine or palladium are placed permanently in the tumor. Because radioactive exposure to others is minimal with permanent implants, radiation precautions are generally not required. However, as an extra precaution, pregnant women (visitors or staff) and very young children should not stay for long time in close proximity of the patient.

High Dose Rate Remote Brachytherapy

High dose rate remote brachytherapy is used to treat people in a short period of time, usually on an outpatient basis. A powerful radioactive source travels by remote control through the catheters placed at the tumor site by doctors. Radioactivity remains at the tumor for only a few minutes which results in less patient discomfort. This procedure is supervised by a brachytherapy team located in a nearby control room. This team watches the patient on closed circuit TV and communicates with him/her through an intercom. Since radioactive materials are not left behind in the patient's body, the patient can usually return home soon after recovery.

Remote brachytherapy can also be used during surgery(intraoperative brachytherapy) to treat difficult to reach body sites. During this process, normal body structures that might be damaged by radiation can be pushed aside or shielded while the area remaining after the tumor is removed is treated.

Side effects of Brachytherapy

Most people are worried about the side effects of exposure to radiation. However, the side effects of brachytherapy are generally minimal because only a small area receives the radiation. The actual side effects of brachytherapy will obviously depend on the area of the body that is being treated.

With a removable implant, patients have the discomfort of staying in the hospital for a few days while the implant is in place. They may feel some fatigue. Patients with uterine implants may have bladder and rectal irritation. Patients with implants in the mouth and throat areas may have temporary sore throat and difficulty swallowing.

Patients with prostate implants frequently complain of urinary frequency and hesitancy for a few months afterwards, although they usually return to their normal activities within a day or so after the implant. Implants have a low chance of causing impotency.

The side effects of brachytherapy may be increased if external beam radiation or chemotherapy is given at the same time. The side effects of brachytherapy usually resolve completely soon after the treatments are completed. Also, medications are available to make the side effects more tolerable.

Is Brachytherapy Curative?

Since brachytherapy gives a high radiation dose, there is a good chance of curing tumors that are small and confined to one area of the body. However, since brachytherapy treats only a small area, it is generally not used to treat large tumors or tumors that have spread to other parts of the body.

What Is New in Brachytherapy

Brachytherapy has been in use since shortly after the discovery of Radium by Marie and Pierre Curie in 1898. However, modern advances in computerization and imaging techniques have led to many new developments since then. Brachytherapy is rapidly becoming a very popular method of treating prostate cancer, with cure rates rivaling those obtained by surgery or external beam radiation.

Brachytherapy has the additional advantage of being able to cure cancer while preserving the function of the body part being treated. In this regard, it has been used to treat tumors in children while allowing continued growth of bone and organs. Brachytherapy is also becoming increasingly popular for treatment of breast cancer is women since the treatment can be completed in one week while preserving the breast cosmesis. While brachytherapy has generally been used to treat cancer, recently it has also been used after angioplasty to prevent restenosis (blockage) of the blood vessels going to the heart.

Although brachytherapy can be used to treat many forms of cancer, it is often not used to the fullest extent due to its unavailability, especially in smaller centers. One should seek the advice of a radiation therapist specializing in brachytherapy to determine whether brachytherapy will be useful in a patient's specific circumstance.

About the author


References/Recommended Reading 

1. Nag S. High Dose Rate Brachytherapy: a Textbook. Armonk, NY: Futura Publishing Company, 1994. 

2. Nag S. Principles and Practice of Brachytherapy. Armonk, NY: Futura Publishing Company, 1997.


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