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Brachytherapy in India

Brachytherapy

Brachytherapy is an advanced cancer treatment. Radioactive seeds or sources are placed in or near the tumor itself, giving a high radiation dose to the tumor while reducing the radiation exposure in the surrounding healthy tissues. The term “brachy” is Greek for short distance. Brachytherapy is radiation therapy given at a short distance: localized, precise, and high-tech. The different types of cancers throughout the body are treated by Brachytherapy that may include –

  • Eye
  • Prostate
  • Vagina
  • Head and Neck
  • Rectum
  • Uterus
  • Skin
  • Gallbladder
  • Cervix
  • Breast
  • Lung

Some of the tumors which can treat with brachytherapy are:

  • Prostate cancer
  • Breast cancer
  • Lung cancer
  • Esophageal cancer
  • Gynecologic cancers
  • Anal/Rectal tumors
  • Sarcomas
  • Head and neck cancers

Equipments used in Brachytherapy

For permanent implants, radioactive material (which is enclosed within small seeds or pellets) is placed directly in the site of the tumor using a specialized delivery device. For temporary implants, needles, plastic catheters or specialized applicators are placed in the treatment site. Different types of radioactive material may be used according to the type of brachytherapy; some types of radiation sources used in brachytherapy are: Iodine, Palladium, Cesium and Iridium. In all cases of brachytherapy, the source of radiation is encapsulated which means that the radioactive material is enclosed within a non-radioactive metallic capsule. This prevents the radioactive materials from entering the patient’s body.

Brachytherapy Types

  • Internal radiation therapy

Internal radiation therapy uses a radiation source that’s usually sealed in a small holder called an implant. The implant is placed very close to or inside the tumor, so that it harms as few normal cells as possible. Internal radiation therapy allows a higher dose of radiation in a smaller area than might be possible with external radiation treatment.

  • Intracavitary (IN-truh-KAV-uh-tair-ee) radiation, the radioactive source is placed in a cavity (space) in the body, such as the rectum or uterus.
  • interstitial (IN-ter-STIH-shul) radiation, the implants are placed in or near the tumor, but not in a body cavity.

Types of Brachytherapy Implant

Temporary Brachytherapy : This type involves the removal of the implants after the completion of the treatment. Balloons filled with fluid, hollow needles and catheters are the different types of implants that are used at the time of treatment that are removed after the completion of the treatment. Low dose or high dose Brachytherapy can also be used.

Permanent Brachytherapy : Seeds or pellets small size implants are used in permanent Brachytherapy. The insertion of these implants is then done in the tumor through the hollow needles. The small-sized implants are then left in place as they do not result in any discomfort or pain.

Brachytherapy Techniques

There are three types of brachytherapy which can be used to treat cervical cancer:1

  • Low dose rate (LDR) brachytherapy
  • High dose rate (HDR) brachytherapy
  • Pulsed dose rate (PDR) brachytherapy

All three types provide effective radiotherapy for cervical cancer, by placing a source of radiation directly next to the cancer. The difference between them is how often the radiation is delivered and how ‘intense’ the radiation is.

Low dose rate (LDR) brachytherapy uses sources that give out a low level of radiation. To deliver the total dose of radiation, the sources have to remain next to the cancer for an extended period of time. Therefore, treatment is usually spread out over the course of one week and requires a stay in hospital.1

high dose rate (HDR) brachytherapy uses sources that give out a higher level of radiation. The total dose of radiation can therefore be given in shorter sessions than LDR brachytherapy.1 As such, patients can often receive treatment on an outpatient basis (i.e. you may not need an overnight stay in hospital).
Pulsed dose rate (PDR) brachytherapy is a cross between LDR and HDR brachytherapy. It provides short pulses of radiation to the cancer using a source that gives out a high level of radiation. However these pulses are spread out (e.g. one short pulse every hour) so that it simulates LDR brachytherapy

Procedure of Brachytherapy

Brachytherapy may be given on a permanent or temporary basis. In permanent brachytherapy, seeds containing the radioactive material are implanted either inside or nearby the tumor. Low dose radiation is gradually absorbed over time and eventually fades after six months.

For temporary brachytherapy, a catheter or applicator is a used to deliver the radioactive material to a target site. In cases of low dose radiotherapy, this material is usually placed in the delivery device for 12 to 24 hours before being removed, while high dose radiation may only be administered for a few minutes. Various different radioactive sources are used in brachytherapy. Some examples include:

  • Radioactive iodine
  • Radioactive palladium
  • Radioactive cesium
  • Radioactive iridium

Once the material is selected, it is delivered to the target site using one of two methods:

  • Hot loading – The radioactive material is placed manually and directly into the target tissue.
  • Afterloading – A delivery device is placed into position using imaging studies and then loaded with the radioactive material by hand (manual afterloading) or by an automated machine (automatic remote afterloading).

Benefits of Brachytherapy

  • is very effective in treating cancer, as the radiation is delivered with a high level of accuracy
  • Has a minimized risk of side effects, due to the targeted and precise nature of delivering the radiotherapy from inside the body
  • Is a minimally invasive technique – i.e. it doesn’t involve extensive surgery
  • Can be performed on an outpatient basis – avoiding the need for an overnight stay in hospital in many cases
  • Requires very short treatment times (typically from 1 to 5 days)
  • Has short recovery times (typically 2 to 5 days) – people can usually return to everyday activities very quickly
  • Requires fewer visits to the hospital and overnight stays than other options
  • The benefits of brachytherapy can enable you to get back to your everyday life sooner with minimal disruption.

How does brachytherapy compare to other treatments?

In terms of the effectiveness of treatment, studies have shown that brachytherapy is comparable to external beam radiotherapy and surgery when treating many types of cancer. For some cancers, more than one type of treatment may be given. Brachytherapy can be used in combination with external beam radiotherapy (EBRT). This can help improve the overall effectiveness of the radiotherapy and limit the side effects from the radiation dose.

Treatment Effectiveness Safety profile Treatment time
Brachytherapy Effective in treating many types of cancer as the radiation is delivered with a high degree of precision from within the body. Radiation is precisely delivered from within the body reducing the risk of unnecessary damage to healthy tissues and organs close to the tumor. This helps reduce the risk of potential side effects. Can be completed in 1-5 days in total; often on an outpatient basis. Quick recovery times (typically 2 to 5 days).
External beam radiotherapy (EBRT) ERBT is effective in treating a wide variety of cancers, as it can be used almost anywhere in the body. EBRT delivers radiation from outside the body. The radiation has to travel through healthy tissue to reach the tumor. Therefore more healthy tissues and organs may be exposed to the radiation. Typically completed over 6-8 weeks of small daily doses. As the radiation passes through healthy tissues, treatment has to be spaced out to limit damage to healthy cells.
Surgery Surgery is very effective in treating tumors that are accessible and have not spread to other parts of the body. Surgery only affects the immediate area being operated on. It can cause scarring and often requires longer recovery times whilst the wound heals. Surgery is usually a one time procedure. It usually requires a stay in hospital and there is often a period of recovery time.
Chemotherapy Chemotherapy is effective in treating many types of cancer. As the treatment (drug) is administered to the whole body it is effective in treating cancer that has spread. The chemotherapy drug is circulated throughout the whole body. Therefore a range of side effects are often experienced. Chemotherapy is usually given in cycles. This allows the cancer cells to be attacked at their most vulnerable time, and gives the body’s normal cells time to recover. Each treatment cycle could last minutes, hours, or days, depending on the cancer being treated.