Brachytherapy

Brachytherapy is a form of internal radiation therapy in which seeds, ribbons, or capsules containing a source of radiation are inserted in, in or near a tumor in your body. Brachytherapy is a local treatment that only targets a particular part of the body. It is commonly used to treat head and neck, breast, cervix, prostate, and eye cancers.

What happens before first brachytherapy treatment ?

Before you begin brachytherapy, you will have a 1- to 2-hour meeting with your doctor or nurse to schedule your treatment. You will have a physical examination at this time ask about your medical history, and maybe have imaging scans. The type of brachytherapy that is best for you will be addressed by your doctor, its advantages and side effects, and how you can take care of yourself during and after treatment. Then you will decide if you should have brachytherapy.

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How brachytherapy is put in place ?

Most brachytherapy, which is a thin, stretchy tube, is placed in place via a catheter. Often, via a larger system called an applicator, brachytherapy is placed in place. The manner in which brachytherapy is placed in place depends on your cancer form. Before you begin treatment, your doctor will insert a catheter or applicator into your body.

Brachytherapy placement strategies include:

  • Interstitial brachytherapy : In which the source of the radiation is located inside the tumor. For example, for prostate cancer, this technique is used.
  • Intracavity brachytherapy : In which the source of radiation is located inside a cavity of the body or a cavity produced by surgery. For example, to treat cervical or endometrial cancer, radiation can be injected into the vagina.
  • Episcleral brachytherapy : In which the source of radiation is connected to the eye. This procedure is used to treat eye melanoma.

The radiation source is put inside it once the catheter or applicator is in operation. For a few minutes, for several days, or for the remainder of your life, the radiation source can be kept in place. Depending on the type of radiation source, the type of cancer, where the cancer is in your body, your health, and other cancer treatments you’ve received, how long it stays in place.

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Types of brachytherapy

There are three types of brachytherapy:

  • Low-dose rate (LDR) implants :The radiation source remains in place for 1 to 7 days in this form of brachytherapy. During this time, you are likely to be in the hospital. Your doctor will remove the radiation source and the catheter or applicator until the treatment has ended.
  • High-dose rate (HDR) implants :The radiation source is left in place for just 10 to 20 minutes at a time in this form of brachytherapy, and then taken out. You can have care for 2 to 5 days twice a day or for 2 to 5 weeks once a week. Depending on the cancer form, the timetable varies. Your catheter or applicator may remain in place throughout the course of treatment, or it may be placed in place before each treatment. During this time, you may be in the hospital or you may make regular visits to the hospital to get the source of radiation placed in place. As with LDR implants, once you have completed treatment, the doctor can remove the catheter or applicator.
  • Permanent implants :The catheter is removed after the radiation source is placed in place. For the remainder of your life, the implants stay in your body, but each day the radiation gets weaker. Almost all the radiation will go down as time goes by. You may need to restrict the time with other people when the radiation is first put in effect, and take other protective precautions. Be extra vigilant in not spending time with kids or pregnant mothers.

Check : Cost of brachytherapy in Malaysia

 

What to expect when the catheter is removed?

The catheter will be removed until you have finished treating yourself with LDR or HDR implants. Some things to expect here:

  • You will get medicine for pain before the catheter or applicator is removed.
  • The area where the catheter or applicator was might be tender for a few months.
  • There is no radiation in your body after the catheter or applicator is removed. It is safe for people to be near you-even young children and pregnant women.

You might need to restrict behaviors that require a lot of work for a week or two. Ask your physician what kinds of things are appropriate for you and which ones you should avoid.

Brachytherapy Makes You Give Off radiation

The radiation source in your body can emit radiation for a while with brachytherapy. If the dose of radiation you receive is very high, certain protective precautions might need to be taken. Such steps can cover:

  • Staying in a private hospital room to protect others from radiation coming from your body
  • Being treated quickly by nurses and other hospital staff. They will provide all the care you need, but may stand at a distance, talk with you from the doorway of your room, and wear protective clothing.

Your visitors will also need to follow safety measures, which may include:

  • Not being allowed to visit when the radiation is first put in
  • Needing to check with the hospital staff before they go to your room
  • Standing by the doorway rather than going into your hospital room
  • Keeping visits short (30 minutes or less each day). The length of visits depends on the type of radiation being used and the part of your body being treated.
  • Not having visits from pregnant women and children younger than a year old

When you leave the hospital, you will still need to obey safety precautions, such as not spending any time with other individuals. When you go home, the doctor or nurse will discuss with you any safety precautions you may take.

Why brachytherapy is done ?

Brachytherapy is used to treat several types of cancer, including:

Brachytherapy may be used on its own or in combination with other therapies for cancer. For example, after surgery, brachytherapy is often used to kill any cancer cells that may remain. Along with external beam radiation, brachytherapy can also be used.

Risks associated with brachytherapy

Brachytherapy side effects are unique to the region being treated. Since brachytherapy in a small treatment area focuses on radiation, only that area is affected.

In the treatment area, you might feel tenderness and swelling. Tell your doctor what can be expected from your treatment for such side effects.

How to prepare for brachytherapy ?

You should visit a doctor who specializes in treating cancer with radiation before you start brachytherapy (radiation oncologist). To help your doctor decide your care plan, you can also undergo scans.

Prior to brachytherapy, procedures such as X-rays, computerized tomography (CT) or magnetic resonance imaging (MRI) can be performed.

What you can expect?

Treatment with brachytherapy means injecting radioactive material near the cancer into the body.

Where the doctor puts the radioactive material in your body depends on several factors, including the cancer’s location and magnitude, your general health, and your goals for treatment.

Within a body cavity or in body tissue, the placement may be:

  • Radiation placed inside a body cavity : A system containing radioactive material is put in a body opening, such as the windpipe or the vagina, during intracavity brachytherapy. The system may be a tube or cylinder made to suit the particular body opening.

The brachytherapy device can be installed by hand by the radiation therapy team or it may use a computerized system to help position the device.

Imaging equipment, such as a CT scanner or an ultrasound system, may be used to ensure that the equipment is positioned where it is most effective.

  • Radiation inserted into body tissue :Devices containing radioactive material are placed within body tissue, such as inside the breast or prostate, during interstitial brachytherapy.

In the treatment area, devices that transmit interstitial radiation include cables, balloons and tiny seeds the size of rice grains. For the injection of brachytherapy instruments into body tissue, a variety of methods are used.

Needles or special applicators can be used by the radiation therapy team. These long hollow tubes, such as seeds, are filled with brachytherapy devices and inserted into the tissue where the seeds are released.

In certain cases, during surgery, narrow tubes (catheters) can be inserted and then filled during brachytherapy sessions with radioactive content.

To direct the devices into place and to ensure that they are placed in the most successful positions, CT scans, ultrasound or other imaging techniques can be used.

High-dose-rate vs. low-dose-rate brachytherapy

During brachytherapy, what you’ll feel depends on your particular care.

Radiation, as with high-dose-rate brachytherapy, may be offered in a brief treatment session or it can be left in place for a period of time, as with low-dose brachytherapy. The source of radiation is sometimes permanently located in your body.

  • High-dose-rate brachytherapy :High-dose brachytherapy is also an outpatient procedure, ensuring that each session of treatment is brief and does not require you to be admitted to the hospital.The radioactive substance is inserted in your body for a brief period of time during high-dose-rate brachytherapy, from a few minutes to 20 minutes. Over a period of days or weeks, you can undergo one or two sessions a day.During high-dose-rate brachytherapy, you can lie in a suitable location. The radiation system will be placed by the radiation therapy team. This can be a simple tube or tubes placed inside a body cavity or tiny needles inserted into the tumor.With the assistance of a computerized system, the radioactive material is placed into the brachytherapy unit.During your brachytherapy session, your radiation treatment team will leave the room. They will be watching you from a nearby room, where they can see and hear you.

During brachytherapy, you shouldn’t feel any discomfort, but if you feel uncomfortable or have any questions, be sure to tell your caregivers.

You won’t give off radiation or be toxic until the radioactive material is removed from the body. You’re not a threat to other citizens, and you can continue with the normal things.

  • Low-dose rate-brachytherapy :A continuous low dose of radiation is emitted over time during low-dose-rate brachytherapy, from several hours to several days. Usually, you’ll live in the hospital while the radiation is in place.

Radioactive material is inserted in your body by hand or by computer. During surgery, brachytherapy devices can be placed that may require anesthesia or sedation to help you stay still during the operation and to decrease pain.

During low-dose brachytherapy, you can typically stay in a private room in the hospital. There is a slight risk that it might damage other people because the radioactive material remains inside the body. Visitors will be limited for this purpose.

In the hospital, kids and pregnant women shouldn’t visit you. Others can visit once a day or so, briefly. You will always be given the treatment you need by your health care staff, but the amount of time they spend in your room could be limited.

During low-dose rate brachytherapy, you do not experience discomfort. It can be uncomfortable to keep silent and stay in your hospital room for days. Inform the health care team if you experience any pain.

The radioactive substance is extracted from your body after a specified period of time. You’re free to have visitors without restrictions once brachytherapy treatment is complete.

  • Permanent brachytherapy :In certain cases, such as with brachytherapy for prostate cancer, radioactive material is permanently inserted in the body.With the aid of an imaging test, such as ultrasound or CT, the radioactive material is usually positioned by hand. You may experience pain during the placement of the radioactive material, but once it is in place, you should not feel any discomfort.Your body will release low doses of radiation from the region that is initially being treated. The hazard to others is usually small and does not require any limits on who can be near you.In certain cases, you might be asked to restrict the duration and frequency of visits to pregnant women or children for a limited period of time. Over time, the amount of radiation in your body can decrease, and restrictions are discontinued.

Results

After brachytherapy, your doctor can prescribe scans to decide if the treatment was successful. Depending on the form and position of your cancer, the types of scans you receive will depend.

Most commonly, brachytherapy is used to treat prostate cancer. It can also be used to treat gynecological cancers such as cancer of the cervix and uterus, as well as breast cancer, lung cancer, rectal cancer, cancer of the eye, and cancer of the skin.

Benefits of brachytherapy

The use of an implant allows for a higher dose of radiation in a small area than would be necessary with traditional externally administered radiation treatments. This can be more successful in killing cancer cells while minimizing damage to normal tissue surrounding them.

How long does the implant stay in the body?

The implants may be temporary or permanent. If the implants will be removed but then put in again later, the catheter is often left in until the treatment is finished. The catheter is then removed when the implants are taken out for the last time. The way you will receive brachytherapy depends on a number of factors, including where the tumor is, the stage of the cancer, and your overall health.

How is brachytherapy delivered?

A physician who specializes in radiation therapy, called a radiation oncologist, uses a needle or catheter in most brachytherapy procedures to insert the encapsulated radioactive material directly on or near a tumor within the body. In certain cases, a radioactive substance, such as the rectum, vagina, or uterus, is placed in a body cavity. For any of those operations, the patient is sedated.

How do doctors know if the radioactive material is going to the right place?

During brachytherapy preparation and delivery, radiation oncologists rely on imaging techniques such as CT scans and ultrasound to ensure that the encapsulated material is positioned with accuracy.

Does brachytherapy require a hospital stay?

It depends on your cancer and the type of brachytherapy you are receiving: Low Dose Rate (LDR) or High Dose Rate (HDR). Usually, LDR brachytherapy does not require an overnight hospital stay. HDR brachytherapy can include a hospital stay for you.

What’s the difference between low dose rate brachytherapy and high dose rate brachytherapy?

With brachytherapy with a low dose rate (LDR), doctors inject tiny radiation-containing seeds into or around the tumor while the patient is under anesthesia. Usually, LDR brachytherapy requires a little over an hour and does not require a stay in the hospital overnight. The seeds are usually permanent, but they cause little to no discomfort and after several weeks or a few months, their radioactivity decreases. In certain cases, the implants are removed after several days, such as when treating eye tumors.

In high dose rate (HDR) brachytherapy, doctors normally offer concentrated radiation bursts within a short period of time. A variety of plastic catheters (tubes) are inserted into or around the tumor, with the patient under anesthesia. The catheters are connected to a system that in the form of radioactive pellets, provides accurate doses of radiation. For skin cancer, HDR brachytherapy uses electronically generated radiation that is provided at the skin surface without need for catheters.

How does brachytherapy compare with other forms of radiation treatments?

Brachytherapy has been shown to be as effective as traditional external beam radiation therapy and surgery for many cancers when used properly. In patients whose cancer has not spread or metastasized, it is best used. In several ways, brachytherapy, like stereotactic body radiation therapy, is paired with external-beam radiation therapy to achieve the best results.

How often is brachytherapy treatment given, and how long do the sessions last?

For LDR brachytherapy, for a prolonged period of time, the radiation sources have to stay inside or next to the cancer. Because of this, care is typically administered over a span of one week and includes a hospital stay.

Treatment is offered in one or two brief (around 15 minutes) sessions for HDR brachytherapy, delivering radiation directly to the tumor. The catheters are removed after the final procedure and you will return home.

How long does the brachytherapy radiation stay in the body?

Your body may give off a small amount of radiation for a short while after treatment. You will be asked to remain in the hospital if the radiation is contained in a temporary implant and will have to restrict your contact with visitors. You may not be permitted to be visited by pregnant women and children. Your body can no longer give off radiation until the implant is removed.

For a couple of weeks to months, permanent implants give off small doses of radiation as they eventually avoid giving off radiation. Usually, the radiation does not move far, so the risk of others being exposed to radiation is very small. Still, you might be asked to take precautions such as staying away from small children and pregnant women, particularly right after treatment.

What side effects may occur as a result of brachytherapy?

Swelling, bruising, bleeding, or pain and irritation at the site where the radiation was applied can be side effects of brachytherapy. Brachytherapy may lead to short-term urinary symptoms, including incontinence or urination pain, when used for gynecologic or prostate cancer. Diarrhea, constipation and some rectal bleeding may also contribute to brachytherapy for these cancers. Occasionally, prostate brachytherapy can cause erectile dysfunction.

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