Fact sheet: Brachytherapy

People who have cancer generally have three treatment options: surgery, chemotherapy and radiotherapy. Radiotherapy, also called radiation therapy, aims to destroy the cancerous cells in a tumour by exposing them to high-energy rays. The source of radiation can either be located outside the body (external radiotherapy) or inside the body (internal radiotherapy or brachytherapy). This fact sheet focuses on brachytherapy. You can read about external radiotherapy in our fact sheet.

What is brachytherapy?

In brachytherapy the radioactive source is very close to the tumour. If it is directly inside the tumour it is called “internal” radiotherapy. In this approach the rays only have a short distance to travel in the body. The Greek word for “short” is “brachys”, and this is where the word “brachytherapy” comes from. Various radioactive substances can be used – some are weaker (low dose rate or LDR brachytherapy) and others are stronger (high dose rate or HDR brachytherapy).

The aim of using radiotherapy in malignant tumours is to destroy the cancer cells, while at the same time trying to limit the damage to the surrounding tissue. This is one of the main goals of brachytherapy, in which radioactive materials are implanted directly into or near the tumour during a small operation. In this way the radiation reaches the tumour directly, thereby minimising the damage done to the healthy tissue. Doctors and researchers are still trying out different types of radiotherapy in order to find out which approach is suitable for different people and situations.

When is brachytherapy used?

Whether or not a cancer is treated with radiotherapy, and brachytherapy in particular, depends on numerous factors: Where (in which organ) is the tumour? How big is it? Has it spread to other parts of the body? If so, to what extent? What kind of tumour is it (in other words, what kind of cells is it made up of)?

Brachytherapy can be used in many parts of the body. There are three main types of brachytherapy which differ in terms of where and how the source of radiation is positioned:

• If it is placed directly on the skin, for example in the treatment of skin cancer, it is known as surface brachytherapy.
• If it is placed inside a cavity, such as the womb, vagina, oesophagus (food pipe) or the bronchi (airways), it is called intracavitary brachytherapy.
• If the radioactive material is implanted directly in the tissue, for example in the prostate gland or breast, it is called interstitial brachytherapy. In this kind of brachytherapy the source of radiation can be put inside the tumour and left there permanently (implanted). Or it can be repeatedly inserted and removed over shorter time periods using a technique called “afterloading”. The radioactive material is enclosed in small devices such as rice-grain-sized capsules (seeds), as well as in wires, needles or tubes.

How do doctors get the source of radiation inside the body?

The process of placing radioactive material inside the body usually involves two steps. First of all, one or several applicators are inserted. These might be thin tubes (catheters or cannulas) made of metal or plastic. The applicators are then used to place the source of radiation, for example in the form of the above-mentioned seeds, in the affected area.

In a procedure called “remote afterloading” the radioactive source is put in place using a kind of robot. Here the patient lies alone in a radiation-proof room but can talk to the doctors and nurses over a microphone. 

The positions of the applicators and radioactive material in the body are usually checked using X-rays, ultrasound, computer tomography or magnetic resonance imaging scans.

How long do you have to stay in hospital?

The brachytherapy procedure can either be done as a day procedure (which means you do not need to stay overnight) or with inpatient care (that is, you have to stay in hospital for a few days). 

How often and for how long the radioactive source is inserted when using an afterloading technique depends on the type of tumour. The sessions might be spread out over one or several weeks. You usually do not have to stay in hospital in between sessions. In rare cases the radioactive source may be left in your body for several hours or even days. Then you might have to stay in hospital for the whole duration of treatment.

How much of the procedure do you feel?

If the treatment is carried out under general anaesthetic, a needle (cannula) will be inserted into your arm first. After the anaesthetic has been injected through the cannula, you will fall asleep and will not feel a thing. When you wake up you might feel dazed and tired for a while.

If the doctor only numbs the area being operated on (local anaesthetic, for example an epidural) you will be awake the whole time and will be able to talk to the doctors throughout the procedure. For certain kinds of brachytherapy you may not need an anaesthetic.

Sometimes the source of radiation is temporarily held in place with an applicator, which can be uncomfortable. Ask the nurses for calming or pain-relieving medication if you think you need it. It is important that you inform them if you sweat excessively, feel a burning sensation or have any other complaints during the treatment.

The source of radiation is sometimes removed from the affected area after treatment. You usually do not need to have an additional operation for this. Some radiation sources, however, are left in place. The radioactive material decays (breaks down) and disappears over several months.

What about the adverse effects?

The affected area might be sensitive or sore for a while following treatment. Most people can return to their usual daily activities after only a few days. According to current knowledge, serious adverse effects following brachytherapy are very rare. However, because it is a relatively new kind of treatment, we do not yet know what effects it might have in the long term.

If you experience problems during or following therapy, your doctor can advise you about what you can do to relieve them.

What should I be aware of following the treatment?

In the kind of brachytherapy where the radioactive material is only temporarily inserted, no radiation is given off in the breaks between treatment and after the treatment is finished. There is no need to take any special safety precautions when you are around other people during this time. Even if a radioactive source is implanted permanently, in most cases the amount of radiation which escapes from the body is minimal because the types of rays used do not travel very far.

However, with some forms of treatment, radiation may be emitted from your body for some time. If this is the case, you might have to stay in a special hospital ward which takes protective measures for a while.

As with any other kind of radiotherapy, it may take weeks or months before you see a result. If the treatment is not as successful as hoped, you can discuss further treatment options with your doctor.

Author: German Institute for Quality and Efficiency in Health Care (IQWiG)

© IQWiG (Institute for Quality and Efficiency in Health Care)