Brachytherapy: A Targeted Cancer Radiation Treatment
Brachytherapy, also known as internal radiation therapy, has become an important part of cancer treatment plans in recent years. This form of radiation therapy involves placing radioactive seeds, pellets or catheters inside the body at or near the tumor site to deliver targeted radiation doses directly to cancerous tissues. Compared to traditional external beam radiation therapy, brachytherapy offers better control of the radiation dose and reduced damage to surrounding healthy tissues.
What is Brachytherapy?
Brachytherapy, from the Greek words 'brachy' meaning short distance and 'therapy' meaning treatment, involves placing radioactive sources inside or next to the area requiring treatment. Small radioactive seeds, capsules or catheters containing radioactive material such as iodine-125 or cesium-131 are carefully placed inside the body using thin applicators, needles or other surgical tools. The placement is done by a radiation oncologist in an operating room using ultrasound, fluoroscopy or other imaging guidance.
Depending on the placement location, brachytherapy is classified as:
- Intracavitary brachytherapy - Sources placed in body cavities like cervix, uterus, vagina, esophagus etc. using applicators.
- Interstitial brachytherapy - Sources implanted directly into the tumor or surrounding tissue using needles or catheters.
- Surface brachytherapy - Sources attached to the skin using molds, gauze or catheters to treat skin cancer and other superficial tumors.
Cancers Treated with Brachytherapy
Some of the most common cancer types treated with brachytherapy include:
- Cervical cancer - Brachytherapy along with external beam radiation and chemotherapy is the standard non-surgical treatment for cervical cancer. Seeds are placed directly into the cervix and top of vagina.
- Prostate cancer - Low dose rate (LDR) or high dose rate (HDR) brachytherapy is used as a monotherapy or in combination with surgery or external beam radiation for localized prostate tumors. Seeds or catheters are placed into the prostate gland through the skin between the scrotum and rectum.
- Breast cancer - Used after lumpectomy to deliver an additional targeted radiation dose and avoid full mastectomy in early stage breast cancer patients. Seeds are placed temporarily inside catheters placed in the breast cavity.
- Skin cancer - For treating basal cell carcinoma and other superficial skin cancers, low dose brachytherapy seeds are often placed on the skin surface using customized molds, dressings or glues.
- Gynecological cancers - Endometrial, vulvar and vaginal cancers are also commonly treated with intracavitary brachytherapy using vaginal cylinders, ovoids and other applicators.
- Other uses - Head/neck, brain, esophageal, bile duct, eye and lung cancers may also be treated with brachytherapy in certain cases using interstitial or intracavitary placement techniques.
Advantages of Brachytherapy
Some key advantages of brachytherapy over traditional external beam radiation therapy include:
- Higher radiation doses can be delivered more precisely to the tumor site while sparing healthy surrounding tissues from excessive exposure. This allows for more targeted cancer cell killing.
- Treatments take less time, usually fractions of minutes to hours compared to minutes daily over several weeks with external beam. This makes brachytherapy more convenient for patients.
- Better tumor control outcomes are seen with brachytherapy for some cancer types like prostate due to the ability to deliver an intense localized dose.
- As an internal radiation source, brachytherapy protects surrounding skin and tissues from unnecessary radiation exposure compared to external beam. This reduces side effects.
- For some tumors like early stage prostate cancer, brachytherapy can be a curative treatment option when used as a monotherapy without the need for additional external beam radiation.
Precautions and Side Effects
While brachytherapy offers several benefits over external beam radiation, some precautions are needed:
- The radioactive sources emit radiation both inside and outside the body, so patients need to follow safety protocols to limit exposure to others until the sources have fully decayed in weeks.
- Placement of sources requires precision using advanced radiologic imaging to minimize risks from surgical procedures in an operating room setting.
- Side effects depend on the treatment area but may include pain, swelling, bleeding, urinary/digestive problems and temporary inflammation at the treatment site. Rarely there are risks of infection too.
- Long term side effects are usually milder than external beam but there is a small risk of complications like fibrosis, tissue damage or secondary cancers due to radiation exposure over years.
- Not all tumors are suitable for brachytherapy and patient eligibility depends on tumor factors like size, location and stage. Combined external beam may still be necessary in some cases.
Brachytherapy continues to play a vital role in personalized, targeted radiation treatments. New techniques using robotic systems for seed/catheter placement, 3D imaging for treatment planning and delivery of pulsed dose rates help improve safety, accuracy and outcomes. With evolving technology and increased experience, brachytherapy will likely expand to benefit more cancer patients in the future.
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