Brachytherapy

Brachytherapy, or internal radiation therapy, is a treatment for cancerous tumors that haven’t spread. Healthcare providers put implants carrying tiny amounts of radioactive material inside or right next to cancerous tumors. The implants release radiation to shrink or destroy tumors without hurting nearby healthy tissue. Your provider may call the implants “seeds”.

You may have brachytherapy after surgery to remove a tumor. Or you might have it along with external beam radiation therapy. It may be a treatment for:

• Breast cancer
• Eye cancer
• Gynecological cancers like uterine, cervical or vaginal cancer
• Head and neck cancer
• Prostate cancer
• Soft tissue sarcomas

It may be an option for head and neck cancers when other treatments aren’t effective.

You may feel anxious about having radiation inside your body or about whether it can affect those around you. Your radiation oncologist will explain how internal radiation works and what you can expect.

Brachytherapy types

Healthcare providers may classify brachytherapy by the dose rate and whether the implant is temporary or permanent. They may you’ll have low dose rate (LDR) or high dose rate (HDR) brachytherapy:

• LDR brachytherapy: The implant releases low doses of radiation over several hours or days. You may have LDR for prostate cancer and some eye cancers.
• HDR brachytherapy: The implant releases high doses of radiation during 10- to 20-minute sessions. HDR treatments are always temporary, so your provider removes the implant after each session. You may have treatment twice a day for up to five days.

As the name suggests, permanent implants stay in your body. They release low doses of radiation over several weeks or months. They’re a common treatment for prostate cancer. This treatment is also called seed implantation.

Temporary implants are removed after your treatment session. Temporary implants may involve both low and high dose rates of radiation.

Treatment benefits

Brachytherapy is a successful treatment for tumors that haven’t spread. For example, research shows that in most cases, brachytherapy can get rid of prostate cancer and keep it from coming back.

Treatment risks

Like other types of radiation therapy, brachytherapy may cause side effects or complications. Side effects vary and depend on the part of your body that’s treated. They may include:

• Diarrhea
• Fatigue
• Nausea and vomiting

Some side effects develop during treatment and stop soon after you’re done.

Brachytherapy complications may include:

• Bleeding
• Difficulty peeing or stopping pee from leaking
• Erectile dysfunction
• Vaginal scarring
• Fecal (bowel) incontinence

Your radiation oncologist will discuss specific side effects and complications with you so you’ll understand how brachytherapy may affect you. They’ll explain ways to manage side effects or treat complications.

They’ll also explain what you need to do to get ready. For example, you may have anesthesia or pain medication before or after your treatment. In that case, someone will need to bring you to your treatment and take you home. If you have treatments over several days, you may need to stay in the hospital.

What happens during brachytherapy?

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

• Interstitial brachytherapy involves putting the implant inside the tumor. 
• Intracavity brachytherapy is when your provider places the implant near a tumor that’s inside a cavity in your body. 
• Episcleral brachytherapy is an eye cancer treatment. Your provider places an implant on your eye.

Intracavity and interstitial brachytherapy follow the same steps. You’ll have anesthesia before treatment. You may have general or local anesthesia. With general anesthesia, you’re asleep during the procedure. Local anesthesia involves medication to numb the area where your provider will place the implant.

Next, your radiation oncologist will:

1. Insert a device to deliver the implant. This may be a catheter or applicator designed to place implants in specific parts of your body.
2. Send the implant through the catheter or applicator. The implant is about the size of a grain of rice.
3. Place the implant in or near the tumor. The implant releases the material.
4. Remove the implant if your treatment involves a temporary implant.

How long will it take for me to feel better after treatment?

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 there anything I can do to make brachytherapy easier on me?

Fatigue and digestive issues are common side effects. You can’t power your way through radiation fatigue, but you can manage it:

• Rest when you need to, not just when you can.
• Schedule activity around the times of day when you have more energy.

Likewise, planning your meals can help prevent issues like diarrhea, nausea and vomiting. For example, eating several smaller meals instead of three large ones may help.

When should I call my healthcare provider?

Brachytherapy may cause serious side effects during or after your treatment. Contact your healthcare provider if you have:

• Trouble breathing or swallowing
• Severe stomach upset, vomiting or diarrhea
• Difficulty peeing or stopping pee from leaking
• Difficulty controlling when you poop

Is brachytherapy successful?

Brachytherapy is a successful treatment for tumors that haven’t spread. Keep in mind that brachytherapy is a treatment for many kinds of cancer. Your radiation oncologist will explain the impact that brachytherapy may have.

Is it safe for other people to be around me after my treatment session?

If you have permanent brachytherapy, there’s a very small risk that you could expose other people to radiation. The risk may last until the implant releases all the radioactive material. This may take a few weeks or months.

Your healthcare provider will explain how you can safely interact with others. They’ll likely advise that you limit close contact with babies, young children and pregnant women. But don’t hesitate to ask questions so you feel comfortable spending time around others.