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Brachytherapy – Definition, Types and Treatment

Brachytherapy is a form of radiation therapy in which radioactive sources are placed directly inside or next to tumor tissue, enabling highly targeted cancer treatment.

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Things worth knowing about "Brachytherapy"

Brachytherapy is a form of radiation therapy in which radioactive sources are placed directly inside or next to tumor tissue, enabling highly targeted cancer treatment.

What is Brachytherapy?

Brachytherapy (from the Greek word brachys, meaning short or close) is a specialized form of radiation therapy in which radioactive sources are placed directly inside the body, in close proximity to or within the tumor itself. Unlike external beam radiation therapy (EBRT), where radiation is directed at the body from outside, brachytherapy delivers radiation from the inside. This allows a very high dose of radiation to be concentrated precisely at the tumor site while minimizing exposure to surrounding healthy tissue and organs.

Types of Brachytherapy

There are several types of brachytherapy, selected based on the type of cancer, its location, and treatment goals:

Intracavitary brachytherapy: The radioactive source is placed inside a body cavity, for example in the uterus or vagina for cervical cancer treatment.
Interstitial brachytherapy: Radioactive needles, wires, or small capsules called seeds are implanted directly into the tumor tissue, commonly used for prostate cancer.
Intraluminal brachytherapy: The source is inserted into hollow organs such as the esophagus, bronchi, or bile ducts.
Surface brachytherapy: Radioactive applicators are placed on the skin surface, typically used for skin tumors.

Dose Rates

Brachytherapy is also classified by the rate at which radiation is delivered:

HDR (High Dose Rate): A highly active source is temporarily inserted and then removed after a few minutes of treatment.
LDR (Low Dose Rate): Weakly radioactive seeds are permanently implanted or left in place for an extended period.
PDR (Pulsed Dose Rate): A pulsed approach combining elements of both HDR and LDR techniques.

Clinical Applications

Brachytherapy is used to treat a wide variety of cancers, including:

Prostate cancer (one of the most common applications)
Cervical cancer and other gynecological tumors
Breast cancer (as a boost treatment after lumpectomy)
Lung cancer
Esophageal cancer
Skin cancer
Head and neck tumors

Advantages of Brachytherapy

Compared to external beam radiation therapy, brachytherapy offers several clinical advantages:

High radiation doses can be delivered directly to the tumor
Reduced radiation exposure to surrounding healthy tissue and adjacent organs
Shorter overall treatment duration (often a few sessions or a single implantation)
Many procedures can be performed on an outpatient basis (especially HDR)
Can be combined with surgery or external radiation therapy

Treatment Process

Before brachytherapy begins, a detailed treatment plan is developed using imaging techniques such as MRI, CT, or ultrasound. This ensures the precise positioning of the radioactive source. During the procedure, applicators (hollow needles, catheters, or templates) are inserted into the body under local or general anesthesia. The radioactive source is then guided through these applicators to the target site. After irradiation, the applicators are removed -- except in LDR seed implantation, where the seeds remain permanently in the body.

Side Effects

Like all forms of radiation therapy, brachytherapy may cause side effects, which are generally confined to the treated area:

Local irritation, redness, or swelling
Fatigue
Bladder or bowel problems (depending on the treatment site)
Sexual dysfunction (e.g., following prostate or uterine treatment)
Rarely: fistula formation or injury to adjacent structures

Most side effects are temporary and resolve after treatment is completed. Serious long-term complications are less common than with external beam radiation therapy.

References

American Brachytherapy Society (ABS): Clinical guidelines and recommendations. americanbrachytherapy.org
Strnad V. et al. - Interstitial brachytherapy for low- and intermediate-risk prostate cancer. Strahlentherapie und Onkologie, 2021.
World Health Organization (WHO): Cancer treatment guidelines. who.int

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