Brachytherapy

Our radiation oncologists are able to provide several types of internal radiation or brachytherapy. Internal radiation may be given as the only radiation treatment or in conjunction with external beam radiation. Some implants require hospitalization and others are performed on an outpatient basis.

Brachytherapy is the temporary or permanent placement of a radioactive source either on or within body tissues or cavities. Also called internal radiation therapy or implant therapy, brachytherapy allows the delivery of a high dose of radiation to a small area while sparing the amount of surrounding normal tissue that is irradiated. The most common methods used to deliver the necessary dose of internal radiation therapy include interstitial implants and intra-cavitary implants.

In an interstitial implant, the radioactive source is contained within a needle, seed, wire or catheter that is placed directly into the tumor or tumor bed. The implant may be temporary or permanent (e.g., prostate seed). Temporary implants can be done with high intensity sources that oscillate within the radiation carrier and are removed within minutes (high dose rate or HDR) or with moderate intensity sources that are maintained within the tumor for hours to days (low dose rate or LDR). Permanent implants, also known as "seed implants," are LDR brachytherapy treatments that utilize radioactive materials that are implanted permanently within the tumor to provide highly localized radiation.

In an intracavitary treatment, the radioactive material is placed directly into the body cavity (such as the uterus) and held in place by an applicator. These are always temporary implants and may be HDR or LDR brachytherapy treatments.

Brachytherapy is often used in the treatment of cancers of the cervix, endometrium, prostate and head and neck area. During your initial consultation with the radiation oncologist, he or she will discuss your treatment plan with you. If an implant is part of the treatment plan, this will be included in the discussion.

Before the implant, the radiation oncologist will discuss the procedure with you again in full detail. The radiation oncology nurse will meet with you to give you verbal and written instructions regarding how to prepare for the procedure, precautions to take, where to report and after-care at home.

High Dose Rate (HDR)

High dose rate or HDR brachytherapy treatments utilize radioactive materials that are placed temporarily in body tissues or cavities. These implants can be done with high intensity sources that oscillate within the radiation carrier and then are removed within minutes.

Hollow plastic tubes or catheters are placed in the area requiring treatment. The end of the catheter that is outside the tissue will be connected to a special machine. Once connected, the staff will leave the treatment room. They will be able to communicate with you through the intercom system and will be watching you at all times via the video monitor. The machine will then be activated remotely having small radioactive sources, which are located within another plastic ribbon or catheter, travel from the housing of the machine to the end of the catheter placed within the tissue or cavity. Once the radioactive sources have been in place long enough to deliver the treatment dose (usually less than 15 minutes) they will travel back to the machine housing. The radiation dose is administered by the radioactive source that travels through the tube to the treatment area to deliver the radiation dose from inside the tissue or cavity to the immediately adjacent tissue. After the sources return to the machine, the staff will re-enter the room and verify the radioactive materials have all been removed. The machine is then disconnected from the end of the catheter. Once the radioactive material is removed, there will be no radioactivity remaining in your body.

In most cases, HDR brachytherapy treatments are done on an outpatient basis, but sometimes (certain prostate and head and neck cancer cases) the placement of the hollow catheters or tubes (through which the radioactive sources will travel) is performed under anesthesia and requires a short hospital stay. This type of implant may be done once a week either during your external beam radiation or for several treatments at its conclusion. It can be used to treat prostate, breast, gynecological, lung and some head and neck cancers, but is rarely the only radiation treatment prescribed.

The weekly sessions take approximately two to three hours and are repeated for a pre-determined number of sessions to achieve the desired radiation dose. In some instances, sedation will be used during the procedure to make it more comfortable. If this is the case, you will be asked to have someone drive you home.

The side effects of HDR brachytherapy are similar to those experienced with external beam radiation.

Low Dose Rate (HDR)

Low dose rate or LDR brachytherapy treatments utilize radioactive materials that are placed either temporarily or permanently in body tissues or cavities. These implants are done with moderate intensity sources that are maintained within the cavity for several hours, days or permanently.

Temporary Implants/Inpatient Implants

This temporary internal placement of radioactive materials may be performed under anesthesia and require a short hospital stay. Hollow plastic tubes or catheters are placed in the area requiring treatment. The plastic tubes are then "loaded" or filled with the radioactive materials, which are located within another plastic ribbon or catheter.

While the radioactive material is in place special precautions must be observed:

• You will be required to remain in your room
• You may have visitors, but the length of their visits may be limited
• Children under 18 years of age and pregnant women are not allowed to visit

When the desired dose of radiation has been delivered, the radioactive ribbons and catheters are removed. Once the radioactive material is removed, there will be no radioactivity remaining in your body and you need not take any further precautions.

The side effects of a temporary implant are similar to those experienced with external beam radiation.

Prostate HDR Brachytherapy

One of the fastest growing and most exciting areas of radioactive implants is the treatment of prostate cancer and HDR brachytherapy may be an option. However, not all patients with prostate cancer are good candidates for HDR Brachytherapy as monotherapy, and your doctor will discuss options that are available to you .

As with any radiation treatment, the first step is an outpatient consultation with a radiation oncologist. By working with your other physicians, a plan that best suits your personal needs and individual situation will be developed. Your suitability for implant will be addressed and the proper type of implant will be recommended.