Brachytherapy

What is brachytherapy?

Brachytherapy (pronounced “bray-kee-THEH-ruh-pee”) is a form of radiation therapy that treats various cancers. Treatment involves placing radioactive seeds, or pellets, capsules or other implants inside or near a tumor. The implants give off radiation for a short time.

Brachytherapy can deliver large amounts of radiation that shrink or destroy tumors while sparing healthy surrounding tissue. You may only need brachytherapy. Or you may get it alongside other cancer treatments, like external beam radiation therapy (EBRT) or surgery.

Brachytherapy is also called internal radiation therapy.

What are the types of brachytherapy?

Types of brachytherapy include temporary and permanent implants.

Temporary implants

Low-dose rate (LDR) brachytherapy

LDR implants release low doses of radiation continually for one to seven days. Then, a provider removes them.

High-dose rate (HDR) brachytherapy

HDR implants release high doses of radiation during treatment sessions that last for 10 to 20 minutes. Providers remove them at the end of each session. Sessions vary from twice a day for up to five days to once a week for up to five weeks.

Permanent implants

These implants release low doses of radiation continually over several weeks or months. The level of radioactivity decreases over time until the implant becomes inactive. The implants remain in your body. This treatment is also called “seed implantation.”

What types of cancer are treated with brachytherapy?

Brachytherapy is effective at destroying tumors that haven’t spread. Brachytherapy treats:

• Prostate cancer
• Gynecological cancers (like uterine, cervical or vaginal cancer)
• Breast cancer
• Eye cancer
• Head and neck cancers

How should I prepare for brachytherapy?

Your healthcare provider will do a physical exam and review your medical history. You may also need blood tests and imaging procedures to help your provider plan treatment.

Your healthcare provider will explain things you should do leading up to brachytherapy. Depending on your situation, you may need to:

• Stop taking medicines that affect blood clotting, like blood thinners (anticoagulants) or NSAIDs.
• Clean out your bowels by using an enema before the procedure.
• Not drink or eat anything for several hours before going to the hospital.
• Quit using tobacco products.

What happens during brachytherapy?

The procedure depends on the cancer and the type of brachytherapy (LDR, HDR or permanent). It also depends on where the radiation oncologist places the implant:

• Interstitial brachytherapy. A healthcare provider places the implants directly inside the tumor. This is what happens during brachytherapy for prostate cancer, some gynecologic cancers, and sarcomas.
• Intracavity brachytherapy. A provider places the implants near the tumor inside a body cavity. This is often what happens during brachytherapy for gynecological cancers (like uterine, cervical and vaginal cancers).

If appropriate and necessary, you’ll receive medicines, like anesthesia, to prevent pain during brachytherapy. Once you’re comfortable, the radiation oncologist will:

1. Insert a catheter or applicator device. Your provider will place the device needed to send the radioactive implants to the tumor. They’ll use imaging to ensure correct placement.
2. Send the implant through the catheter or applicator. They’ll place the implant inside or near the tumor. The implant will release a prescribed radiation dose that kills cancer cells.
3. Remove the implant (temporary forms of brachytherapy only). With HDR, your provider will remove the implant after each treatment session. With LDR, they may remove the implant after each session and re-insert it during future sessions.

If appropriate, you’ll receive pain medicine to ease any discomfort once it’s time to remove the catheter or applicator device.

How long does it take?

Brachytherapy procedures take anywhere from 30 minutes to a few hours. How long the treatment lasts in total depends on the type of brachytherapy:

• HDR brachytherapy. The implants stay in for several minutes before a provider removes them. You may need several sessions daily spread out over a week or once a week spread out over several weeks.
• LDR brachytherapy. The implants may remain inside your body for a day up to a week. Permanent forms of LDR stay in your body forever. Eventually, the implants stop giving off radiation.

What happens after getting brachytherapy?

After the procedure, healthcare providers will take you to a recovery room. They’ll monitor you and help manage any pain.

You may get to go home on the same day as your procedure. If you do, you’ll need someone to drive you if you received pain medications or anesthesia as part of your procedure. Or, you may need to stay in the hospital overnight to recover from the procedure. Sometimes, you’ll stay in the hospital if you have treatments spread out over several daily sessions.

What are the benefits of brachytherapy?

Brachytherapy is an effective cancer treatment for localized tumors. The implants give off a powerful dose of radiation that blasts tumors without harming healthy tissue away from tumors. Less damage means there’s a reduced risk of side effects related to radiation exposure. The recovery time for brachytherapy can be shorter than some other types of cancer treatment.

How successful is it?

Brachytherapy is a successful treatment for tumors that haven’t spread. For example, a recent study shows healthcare providers are increasingly using brachytherapy to help people with cervical cancer live longer. Research also shows that in some cases, brachytherapy can get rid of prostate cancer and keep it from coming back.

Still, no two cancer diagnoses are the same. Ask your healthcare provider about the likely outcomes of brachytherapy treatment based on your unique diagnosis.

What are the risks or complications of brachytherapy?

Potential side effects depend on the cancer type and the type of brachytherapy you receive. Side effects typically improve once the radiation leaves your body. But some are long-term or don’t appear until after treatment ends.

Potential side effects include:

• Difficulty peeing (urinating) or stopping pee from leaking (urinary incontinence)
• Erectile dysfunction
• Vaginal scarring
• Fatigue
• Fecal (bowel) incontinence, constipation or diarrhea
• Nausea and vomiting

Usually, side effects occur in the body part where the implant is. For example, with a prostate gland seed implant, you may experience symptoms impacting how you pee or poop, but not nausea and vomiting.

What is the recovery time?

Brachytherapy may involve a shorter recovery time than other cancer treatments, like surgery. Depending on the procedure, you may feel better within a few days up to a week.

You may need to limit your activity and get extra rest after treatment. Follow your healthcare provider’s guidance on when it’s safe to return to your usual routine.

Is it safe to be around someone with brachytherapy?

Follow your provider’s instructions on how to interact with others safely after brachytherapy. For example, if you have permanent brachytherapy, you may expose other people to radiation for several weeks or months. The exposure risk is small. But you should limit your contact with young children and people who are pregnant as directed by your healthcare provider. With temporary brachytherapy, there isn’t any exposure to other people around you.

Still, it’s important to know that the radiation the implant releases doesn’t usually travel beyond the tumor. This is why it kills tumors without harming nearby tissue.

When should I call my healthcare provider?

Call your healthcare provider if you experience any of the following symptoms during or after treatment:

• Trouble breathing or swallowing
• Severe stomach upset, vomiting or diarrhea
• Urinary incontinence
• Fecal incontinence