Fact sheet: Brachytherapy

People who have cancer (malignant tumor) generally have three treatment options: surgery, chemotherapy and radiotherapy. Radiotherapy, also called radiation therapy, aims to destroy the cancer tissue by exposing it to certain high-energy rays. The source of radiation can be located outside the body (external radiotherapy) as well as inside the body and very close to the tumor (internal radiotherapy or brachytherapy). This fact sheet focuses on brachytherapy. You can read about external radiotherapy in our fact sheet “External radiotherapy” (URL: http://www.informedhealthonline.org/index.304.en.html) .

What is brachytherapy?

In brachytherapy the radioactive source is either placed very close to the tumor or directly into the tumor. 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 for internal radiotherapy – some are weaker, and others are stronger.

The aim of using radiotherapy in malignant tumors is to destroy the cancer cells, while at the same time trying to limit the damage to the surrounding healthy tissue. This is one of the main goals of brachytherapy, in which radioactive materials are implanted directly into or near the tumor during a small operation. In this way the radiation reaches the tumor directly, thereby minimizing the damage done to the healthy tissue. Doctors 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 is the tumor? How big is it? Has it spread to other parts of the body? If so, to what extent? What kind of tumor is it (for example, 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:

• Surface brachytherapy: The source of radiation is placed directly on the skin, for example in the treatment of skin cancer.
• Intracavitary brachytherapy: The source of radiation is placed inside a cavity, such as the womb, vagina, food pipe or the bronchi (airways).
• Interstitial brachytherapy: In this type of brachytherapy, the source of radiation is placed directly into the tissue, for example in the prostate gland or breast. There are two options: The radioactive material is placed in the tissue and left there permanently (implanted) in small containers – capsules about the size of a grain of rice (seeds). It remains there, and the radiation decreases over the course of several months. Or the source of radiation is repeatedly inserted and removed over shorter time periods. Surgery is usually not necessary to do this.

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

The process of placing radioactive material inside the body usually involves several steps. First of all, one or several applicators are inserted. These might be thin tubes (catheters or cannulas) made of metal or plastic.

The doctor will then check whether they are in the right place using X-rays, ultrasound, computed tomography or magnetic resonance tomography scans. If this is the case, the radiation source is placed in the body.

In an afterloading procedure, 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 through a microphone. They may need to double-check the patient’s position. This has the advantage of keeping medical staff from coming into direct contact with the source of radiation.

How long do you have to stay in the hospital?

The brachytherapy procedure can either be done as an outpatient service, so that you can go home on the same day, or with inpatient care and you 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 tumor, among other things. The sessions might be spread out over one or several weeks. You usually do not have to stay in the hospital between sessions. The radioactive source is usually taken out again after a short time. In rare cases the radioactive source needs to be left in your body for several hours or even days. Then you will have to stay in the hospital for the whole duration of treatment.

How much of the procedure do you feel?

If the treatment is carried out under general anesthetic, a needle (cannula) will be inserted into your arm first. After the anesthetic has been injected through the cannula, you will fall asleep and will not notice a thing. You will not wake up completely before you are in the recovery room. Afterwards you will still feel dazed and tired for a while.

If the doctor uses local anesthetic, 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 anesthetic at all.

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, feel a burning sensation or have any other complaints during the treatment.

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, severe adverse effects following brachytherapy are rare. However, there has not been enough conclusive research to know exactly what effects this treatment might have in the long term.

If you experience problems during or following therapy, you can talk to your doctor 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 that 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 for a while in a special hospital ward that will take protective measures.

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