Brachytherapy is a type of internal radiotherapy, which involves putting a solid radioactive material close to, or inside, the tumour.
There is another type of internal radiotherapy called radioisotope therapy.
Brachytherapy gives a high dose of radiotherapy directly to the tumour but only a low dose to normal tissues. Brachytherapy is used mainly to treat cancers in the prostate gland, cervix, womb, or head and neck, but it can be used to treat other cancers.
If you have brachytherapy you may have to stay in hospital for a few days, and special safety measures will be taken while the radioactive material is in your body. Once the treatment is over, there is no risk of exposing your family or friends to the radiation.
Brachytherapy for prostate cancer
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Brachytherapy using radioactive seed implants is sometimes used to treat small tumours of the prostate gland. It may be given in combination with external radiotherapy.
Prostate brachytherapy is only available in some hospitals in the UK, so you may have to travel for this treatment.
It’s carried out under a general anaesthetic or sometimes a spinal anaesthetic (epidural). Small radioactive metal seeds are placed into the tumour within the prostate gland. They release small doses of radiation very slowly over a period of time. The seeds are not removed, but stay in the prostate gland permanently.
Before the seeds are implanted, you’ll usually need a planning visit to the hospital. The seeds are implanted during a single session so you can usually go home on the same day, although some men may need to stay in hospital overnight.
The radioactivity gradually fades away over about a year. The radiation only affects the area a few millimetres around the seeds, so there is no danger of it affecting other people.
Brachytherapy for cancer of the cervix or womb
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In the treatment of cancers of the cervix or lining of the womb (endometrium), brachytherapy (also sometimes called intracavitary therapy) can be used on its own or combined with external radiotherapy. The treatment is often given before or after surgery.
A piece of radioactive material called a source is put close to the cancer or, if you’ve had surgery, the area where it was before being removed. The source is placed inside hollow plastic or metal tubes called applicators, which are positioned at the top of the vagina. These keep the source in place. Sometimes only one tube is used.
The applicators are placed inside the vagina while you’re under a general anaesthetic or sedation in the operating room. The applicators are kept in place by a pack (cotton/gauze padding) inside the vagina. This can be uncomfortable but you can have regular painkillers to ease any discomfort.
At the same time, a flexible tube called a catheter may be put into your bladder to drain off urine. This means that during your treatment you won’t risk dislodging the applicators if you have to move around to pass urine.
Once the applicators are in place, an x-ray will be taken to check they’re in the correct position. Sometimes the radioactive source is put into the applicators while you’re in the operating room, but more commonly it will be put in place once you’re back on the ward in your own room.
Internal radiotherapy may be given as low dose rate treatment or high dose rate treatment. Both low dose rate and high dose rate treatment give the same total dose of radiotherapy but do so over different time periods.
Once the source is in place, you have to stay in bed so that the applicators don’t move out of position. If you need anything, you can call a member of staff by using the buzzer by your bed.
Many women find the prospect of this treatment worrying. It’s important to talk things through with your cancer specialist so that you understand as much as you need to about what your treatment involves. Some hospitals have specialist nurses who are trained to give advice and support to women having treatment for gynaecological cancer. Ask your cancer specialist about the kind of help available in your hospital.
Low dose rate treatment
In many hospitals a machine called a Selectron, or a similar name, is used to put the radioactive material into the applicators. The machine is attached by tubes to the applicators. When the machine is switched on, it passes small radioactive balls into the applicators. If the machine is switched off, the radioactive balls are pulled back inside the machine. The machine is kept switched on throughout treatment, except when someone needs to go into your room. It can then be turned off to reduce their exposure to the rays. However, safety measures and visiting restrictions are still necessary.
The time you spend on the machine varies, but it’s usually between 12-48 hours.
High dose rate treatment
Sometimes a machine called a Microselectron is used for internal radiotherapy. It gives a higher dose of radiotherapy over a shorter period of time, so the treatments last only a few minutes and you can go home on the same day. Treatments may be repeated several times, a few days apart.
After the treatment
Once the treatment is completed, the source and the applicators will be removed. This is usually done in your own room on the ward rather than in an operating theatre. As it can be a little uncomfortable, you will be offered some painkillers beforehand. Sometimes a few breaths of the gas Entonox® will help you relax. Staff on the ward will check that all the applicators and sources have been removed. Your catheter may be removed at the same time.
Your cancer specialist may suggest that you use vaginal douches for a few days after the applicator has been removed. Vaginal douches are a way of rinsing the vagina to keep it clean. The nurses will tell you more about this.
You will probably be able to go home on the same day or the day after. Once the radioactive sources are removed, all traces of radioactivity disappear immediately.
Caesium or iridium wire brachytherapy
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These can be used to treat a number of different cancers including mouth, lip, cervical and breast cancer. Very thin radioactive needles, wires or tubes are inserted while you are under general anaesthetic in the operating room.
An x-ray may be taken to ensure that the needles are in the correct position. You will be in a room on your own, and safety measures will be used until the wires are removed, which usually happens after 3-8 days. Sometimes the wires are removed under a general anaesthetic.
Wires in the mouth can be uncomfortable, and can make eating and talking difficult. You will need to have a soft or liquid diet while they are in place. Your nurse will show you how to keep your mouth clean by using mouthwashes regularly. If eating is a problem, you may be fed through a thin tube (a nasogastric or NG tube), which is passed up your nose and down into your stomach.
Once the wires have been removed, the area will feel sore for up to 2-3 weeks afterwards. Your clinical oncologist will prescribe painkillers for you to take regularly until this improves.
After caesium or iridium wire brachytherapy, there is a slight risk of infection, but this is very rare. If you develop a high temperature or heavy bleeding after your treatment, contact your clinical oncologist as soon as possible so they can prescribe antibiotics to treat the infection.