Brachytherapy – types, indications, preparation, course, benefits and side effects

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Brachytherapy, also called contact therapy or curieterotherapy, is a form of radiation therapy. It consists in irradiating neoplastic cells by placing a radiation source in the vicinity of the target tumor.

Brachytherapy – what is it?

Brachytherapy is one type of radiation therapy used to treat cancer. Brachytherapy is sometimes called internal radiation. Brachytherapy involves placing radioactive material inside the body.

Brachytherapy allows doctors to deliver higher doses of radiation to more specific areas of the body compared to a conventional form of radiation therapy (external beam radiation) that emits radiation from a machine to the outside of the body.

Brachytherapy can cause fewer side effects than external beam radiation, and the overall treatment time is usually shorter with brachytherapy.

Most brachytherapy is delivered through a catheter, which is a small, stretchable tube. Sometimes brachytherapy is done with a larger device called an applicator. The way brachytherapy is performed depends on the type of cancer you have. Your doctor will insert a catheter or applicator (implant) into your body before starting treatment.

Brachytherapy placement techniques include:

1. interstitial brachytherapy – in which the radiation source is placed within the tumor. This technique is used, for example, in prostate cancer,
2. intracavitary brachytherapy – in which a radiation source is placed in a body cavity or a cavity created surgically. For example, radiation may be placed in the vagina to treat cervical or endometrial cancer.
3. epidural brachytherapy – in which a source of radiation is attached to the eye. This technique is used to treat eye melanoma.

After the catheter or applicator is placed, the radiation source is placed in it. The radiation source can be held in place for several minutes, many days, or for the rest of its life. How long it stays in place depends on the type of radiation source, type of tumor, where the tumor is in the body, health, and other treatments used.

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Brachytherapy – specificity

Brachytherapy is an extremely precise form of cancer treatment. It enables the precise targeting of radiation to the site affected by neoplastic changes, while reducing the risk of damage to healthy tissues. For this reason, brachytherapy is used in the treatment of neoplasms in areas sensitive to ionizing radiation.

The high level of advancement of this form of treatment is associated with certain drawbacks. The use of brachytherapy requires a long period of treatment planning, during which complicated techniques of computer diagnostics are used.

Brachytherapy – types

Radiation in brachytherapy is administered in high doses, which poses a potential threat to the procedure. In addition, the need to place the radiation source inside the body precludes the treatment of some cancers (for example, the brain).

Therefore, the following types of brachytherapy are distinguished.

1. High-dose brachytherapy (HDR) – implants (catheter) are inserted once a day for a few minutes and then removed. The implant tube can be removed after each treatment session or it can remain in place. You can go home between treatments or stay in hospital until all therapeutic sessions are over,
2. Low-dose brachytherapy (LDR) – implants and delivery device remain in place for hours or even days. You are in the hospital during this time,
3. Permanent brachytherapy – implants are inserted and not removed. Very low doses of radiation are given, but this wears off over time.

Brachytherapy is an increasingly popular form of cancer treatment. It has been used in the world for over 30 years. In Poland, it is reimbursed and available in facilities in, among others: Gliwice, Poznań, Bydgoszcz, Łódź and Warsaw.

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Brachytherapy – indications

Brachytherapy is recommended in the following cases of cancer:

1. prostate gland,
2. floor of the mouth,
3. language,
4. cheek and lips,
5. leather
6. prostate,
7. breasts
8. cervix,
9. vagina, vulva,
10. digestive tract,
11. respiratory tract.

Most often, brachytherapy is used in conjunction with other forms of cancer treatment, such as teleradiotherapy or surgery. Less frequently, brachytherapy is used as an independent form of treatment.

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Brachytherapy – how to prepare?

Before starting brachytherapy, your doctor will decide what tests you will need. These can include blood tests, an electrocardiogram (EKG), chest X-ray, CT scan, or ultrasound of a specific area of ​​the body.

A few days before starting brachytherapy, you will receive detailed preparation instructions. Follow these instructions closely. Tell your doctor about all medications you take. This includes over-the-counter and prescription medications, vitamins, herbs, and other supplements.

You may need to stop taking certain medications and supplements before surgery. You may need to stop taking aspirin and over-the-counter pain relievers and anti-pyretics (called NSAIDs or non-steroidal anti-inflammatory drugs). These can cause bleeding problems. In addition, follow the directions you will receive not to eat or drink before the procedure.

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Brachytherapy – course

Treatment with brachytherapy begins with giving the patient an appropriate form of anesthesia. For most cancers, this is called general anesthesia; local anesthesia is used in the case of neoplasms located in the oral cavity. Then, with the help of an X-ray or ultrasound machine, the place subjected to neoplastic changes is precisely identified. Through the skin, a localized neoplasm is reached, on which special applicators are placed that perform a series of scans.

After the patient wakes up, the rest of the treatment begins. It involves connecting the patient to a brachytherapy device. It sends radiation lasting several minutes, during which the patient should not make any movements. After the radiation is over, the applicators are removed from the patient’s body. Usually, one day after the procedure, the patient may leave the facility where the procedure was performed.

The radiation applicator in brachytherapy is most often in the form of a plastic tube (catheter) that is inserted into the patient’s body. Different forms of radiation source application, such as needles made of the radioactive iodine isotope, are used less frequently.

In this case, the radiation source is permanently placed in the patient’s body, but due to its short half-life, it loses its activity over time. The application itself takes place in a special room called a bunker, where only the patient is present during the therapy.

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Brachytherapy – advantages

Brachytherapy can be very effective in treating some types of cancer. Here are the benefits of the brachytherapy treatment method:

1. since the radiation source is positioned directly next to or inside the tumor, this allows a reduction in dose emission to surrounding healthy tissue, which could potentially lead to fewer complications.
2. in the treatment of some types of cancer, brachytherapy may require fewer treatment sessions than external beam radiotherapy, usually from 1 to 5 days,
3. brachytherapy may be performed on an outpatient basis, which means that the patient may return home after treatment,
4. although recovery time depends on the area treated, it is usually short. Typically, patients are able to continue their daily activities after treatment. However, fatigue can last for several days, depending on the brachytherapy technique used.

Brachytherapy – possible side effects

The most common side effects of brachytherapy include:

1. skin irritation,
2. exfoliation of the epidermis,
3. oozing of serous contents,
4. itch,
5. pain,
6. bleeding at the puncture site,
7. inflammation,
8. edema,
9. breast abscess (if you are treated for breast cancer)
10. fat necrosis.