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Brachytherapy

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What is brachytherapy and how is it used? 
Who will be involved in this procedure? 
What equipment is used? 
Who operates the equipment? 
Is there any special preparation needed for the procedure? 
How is the procedure performed? 
What will I feel during this procedure? 
 

 

What is brachytherapy and how is it used?

Brachytherapy is one type of radiation therapy used to treat cancer. Radiation therapy is the use of a type of energy, called ionizing radiation, to kill cancer cells and shrink tumors.

Unlike external beam therapy (EBT), in which high-energy x-ray beams generated by a machine are directed at the tumor from outside the body, brachytherapy involves placing a radioactive material directly inside the body.

Brachytherapy, also called internal radiation therapy, allows a physician to use a higher total dose of radiation to treat a smaller area and in a shorter time than is possible with external radiation treatment.

Brachytherapy is used to treat cancers throughout the body, including the:

  • Prostate
  • Cervix
  • Head and neck
  • Ovary
  • Breast
  • Gallbladder
  • Uterus
  • Vagina 
     

Brachytherapy may be either temporary or permanent:

In temporary brachytherapy, the radioactive material is placed inside or near a tumor for a specific amount of time and then withdrawn. Temporary brachytherapy can be administered at a low-dose rate (LDR) or high-dose rate (HDR). Low-dose rate brachytherapy is also used in the treatment of coronary artery disease to prevent the artery from becoming blocked again after angioplasty

Permanent brachytherapy, also called seed implantation, involves placing radioactive seeds or pellets (about the size of a grain of rice) in or near the tumor and leaving them there permanently. After several weeks or months, the radioactivity level of the implants eventually diminishes to nothing. The seeds then remain in the body, with no lasting effect on the patient.

Who will be involved in this procedure?

The delivery of brachytherapy requires a treatment team, including a radiation oncologist, radiation physicist, dosimetrist and radiation therapist. The radiation oncologist is a physician who evaluates the patient and determines the appropriate therapy. He or she determines what area of the body to treat and how much radiation to deliver. Together with the radiation physicist and the dosimetrist, the radiation oncologist determines what techniques to use to deliver the prescribed dose. The physicist and the dosimetrist then make detailed treatment calculations. The radiation therapists are specially trained technologists who deliver the treatments.

What equipment is used?

Radioactive material (such as seeds or pellets) is pushed to the site of the tumor through a delivery device, such as a needle, catheter or applicator—both of which are thin, hollow tubes—or a single-balloon catheter that is inserted into a body cavity and then inflated. The physician may manually insert and remove the radioactive material immediately after placing the delivery device, or later using a computer-controlled machine. X-rays, ultrasound or CT scans may be used to help position the radioactive material to most effectively treat the tumor. In treatment planning, a computer is used to help calculate the amount of time needed to deliver the correct dose of radiation to the tumor.

Who operates the equipment?

The equipment is operated by a radiation physicist, a licensed dosimetrist who is supervised by a physicist, or a radiation oncologist. The overall treatment plan is created by the radiation oncologist, who is a highly trained physician specializing in treating cancer with radiotherapy.

Is there any special preparation needed for the procedure?

Your physician will determine which tests need to be done prior to your brachytherapy procedure.  These may include:

Your physician may also schedule an examination of the tumor with the help of imaging studies and a sophisticated computer program to plan the brachytherapy treatment. A few days before your procedure, you will be given specific instructions on how to prepare for your brachytherapy procedure.

How is the procedure performed?

In permanent brachytherapy, also called seed implantation, needles that are pre-filled with the radioactive seeds are inserted into the tumor. The needle or device is then removed, leaving the radioactive seeds behind. Seeds may also be implanted using a device that inserts them individually at regular intervals. X-rays, ultrasound or CT scans may be used to assist the physician in positioning the seeds. Additional imaging tests may be done after the implantation to verify seed placement.

In temporary brachytherapy, a delivery device such as a catheter, needle, or applicator is placed into the tumor using fluoroscopy, ultrasound or CT to help position them. The physician may insert the radioactive material at the same time manually through the delivery device and later remove the material and delivery device.

Alternatively, the patient may be moved to a hospital room where the delivery device is connected to a remote-controlled machine, which pushes the radioactive material to the tumor site. This is called an afterloaded implant. After a specified amount of time, the radioactive material is withdrawn back into the machine and disconnected from the delivery device. The delivery device is then removed from the patient.

High-dose rate (HDR) brachytherapy is usually an outpatient procedure. A specified dose of radiation is delivered via a remote-controlled machine to the tumor in a short burst, lasting only a few minutes. This may be repeated several times in a day before the delivery device is removed and the patient returns home. Patients may receive up to 12 separate HDR brachytherapy treatments over one or more weeks.

In the low-dose rate (LDR) brachytherapy procedure, the patient is treated with radiation delivered at a continuous rate over several hours or days. This treatment may be delivered using a manually or remotely afterloaded implant. A patient receiving LDR brachytherapy stays overnight at the hospital so the delivery device can remain in place throughout the treatment period.

What will I feel during this procedure?

Before the brachytherapy procedure begins, an intravenous line may be inserted into your arm or hand to deliver anesthetic medications. Depending on the site of the tumor and your physician’s recommendations, you may receive general anesthesia and/or a sedative to make you feel drowsy. Following the procedure, patients rest in a hospital or recovery room. Many patients return home the same day; others may require a short stay in the hospital.

Your physician and/or treatment team will give you specific home-care instructions. You may experience tenderness and swelling in the treatment area and/or other symptoms depending on your specific procedure. Most patients are able to resume normal activities within days of brachytherapy.

As your brachytherapy treatment progresses, you may experience treatment-related side effects. Members of your treatment team can advise you on managing the anticipated side effects be of your brachytherapy treatment.

Patients who have an afterloaded implant for temporary brachytherapy may hear a clicking or humming noise from the treatment machine as the radioactive material is being pushed to the tumor site. Although you will be alone during the procedure, you will be able to speak via a speaker with members of your treatment team, who will be located nearby, where they can see and hear you.

In LDR brachytherapy treatment, which requires a stay in the hospital so the delivery device can remain in place throughout a multi-day treatment period, you may experience discomfort related to having to stay relatively still for up to 72 hours. Your physician will prescribe medications to help relieve this.

Following permanent brachytherapy, in which radioactive seeds are implanted permanently in the body, the radioactivity of the seeds decays very quickly with time. However, you should discuss with your physician any specific recommendations for limiting close contact with others, such as pregnant women or children.

Source: http://www.radiologyinfo.org

 

                   

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