What is Brachytherapy?
Brachytherapy, also known as internal radiotherapy, is a type of radiation therapy where a radioactive source is placed inside or near the area requiring treatment. Unlike external beam radiation therapy that beams radiation from outside the body, brachytherapy puts the source of radiation inside the body allowing for a higher radiation dose to be delivered directly to the tumor while minimizing exposure to surrounding healthy tissue.
How is it Done?
There are two main types of brachytherapy - high-dose-rate (HDR) brachytherapy and low-dose-rate (LDR) brachytherapy. In HDR Brachytherapy, a radioactive source on the end of a wire is inserted through a catheter and placed in or near the tumor site for a short time before being removed. In LDR brachytherapy, radioactive "seeds" or pellets are surgically implanted around the tumor site and left there permanently to deliver a continuous low dose of radiation over weeks. The type of brachytherapy used depends on the location and size of the tumor.
Common Cancer Types Treated
Prostate cancer is one of the most common types treated with brachytherapy. Radioactive seeds are implanted directly into the prostate using transrectal ultrasound guidance. Other common sites include the cervix, head and neck regions, breast, skin, and eye. Brachytherapy can be used to treat primary tumors as well as cancer recurrence after previous treatment like surgery. It is often combined with external beam radiation therapy for more advanced cancers.
Advantages Over Other Therapies
One of the major advantages of brachytherapy is its ability to deliver a highly localized dose of radiation directly to the tumor site. This allows for better tumor targeting while minimizing damage to surrounding healthy tissue. Brachytherapy treatments are also usually completed in less time compared to weeks of daily external beam treatments. For some low-risk prostate cancers, brachytherapy alone may be sufficient without needing additional external beam radiation or surgery. Other advantages include shorter treatment times, less chance of side effects, and better quality of life after treatment compared to other options.
Procedure and Aftercare Details
For HDR brachytherapy treatments, catheters are typically inserted into the tumor site during a brief outpatient procedure done under local anesthesia. The patient is then taken to the treatment room where the radioactive source is advanced down the catheters and left in place for a preset time before being retracted. Multiple treatments may be required based on the tumor. For LDR brachytherapy, the radioactive "seeds" are implanted directly into the tumor site during surgery requiring only a short hospital stay. After implantation, the seeds remain in place permanently to continue emitting low-dose radiation over time. Recovery time is usually shorter compared to other therapies. Patients will need checkups and follow up visits after brachytherapy to monitor treatment response and side effects.
Potential Side Effects
While brachytherapy is effective at targeting tumors, some side effects are still possible depending on factors like treatment location and individual patient factors. Common temporary side effects for prostate brachytherapy include urinary problems, erectile dysfunction, diarrhea, and fatigue. More serious but rare side effects include bleeding, infection, and damage to nearby organs. Permanent side effects are less common with modern techniques but can include urinary/bowel problems or erectile dysfunction. However, side effects are usually milder than with external beam radiation or surgery. Ongoing follow up after brachytherapy helps minimize risks of complications.
Outcomes and Future Perspectives
Modern brachytherapy techniques have resulted in excellent cancer control and survival rates for many tumor types when used alone or combined with other therapies. 5-year survival rates after prostate brachytherapy approach 90% for low-risk disease. Ongoing technological advancements aim to further improve radiation targeting capabilities to allow for dose escalation without increased toxicity. Areas of active research also include developing image-guided systems and combining brachytherapy with immunotherapy or targeted drugs. With continued advances, brachytherapy will likely play an increasingly important role in personalized cancer care.
Brachytherapy offers a targeted internal radiotherapy approach that can deliver high radiation doses directly to tumors while minimizing surrounding healthy tissue exposure. As techniques improve, brachytherapy provides an effective treatment option alone or combined with other modalities for many cancer types with shorter treatment times and often fewer side effects than alternative options. Ongoing research seeks to further maximize tumor control and quality of life outcomes through brachytherapy.
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