Brachytherapy

BRACHYTHERAPY IN INDIA

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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 or next to the tumor.

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.

How Does Brachytherapy Work ?

There are three types of Brachytherapy delivery:

    • Intracavitary Treatment – radioactive implants are placed inside body cavities such as the vagina or uterus.
    • Interstitial Treatment – radioactive implants are placed directly into the tumor and may stay in the patient permanently.
  • Unsealed Internal Radiation Therapy – a medication containing radioactive materials is injected into a vein or into a body cavity.

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Brachytherapy implant placement may be one of two types:

    • Permanent Brachytherapy
      Also called low dose rate brachytherapy, permanent brachytherapy uses implants called pellets or seeds. These implants are very small, about the size of a grain of rice. The implants are inserted directly into a tumor through thin, hollow needles. The implants are left in place after the radiation has been used up, as their small size causes little or no discomfort.
  • Temporary Brachytherapy
    Temporary brachytherapy refers to the use of implants that are removed after the treatment has ended. Implants, such as hollow needles, catheters (hollow tubes), or balloons filled with fluid, are inserted into or near the cancer for a period of time, then removed. Either high-dose or low-dose brachytherapy may be used.

During the Procedure

Brachytherapy is usually an outpatient procedure, which means you most likely will not have to spend the night at the hospital or be admitted. The actual procedure takes approximately 1 hour. Most people receive spinal anesthesia, which means that you are numb from the waist down. You may also receive medication to make you feel drowsy.

An ultrasound probe is inserted into the rectum, which will show the prostate gland on a television monitor, to aid the doctor in placement of the seeds. The seeds are then implanted into the prostate through very thin needles. Depending on different variables, between 50 and 100 seeds are used. The types of seed also vary and may include Iodine-125, Palladium-103, and echnogenic Iodine-125 seeds. The needles are inserted into the skin between the scrotum and rectum and are guided to the right place to most effectively treat the cancer. At the end of the procedure, a catheter will be placed in your bladder to help you pass urine during recovery.

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During the Procedure

Brachytherapy is usually an outpatient procedure, which means you most likely will not have to spend the night at the hospital or be admitted. The actual procedure takes approximately 1 hour. Most people receive spinal anesthesia, which means that you are numb from the waist down. You may also receive medication to make you feel drowsy.

An ultrasound probe is inserted into the rectum, which will show the prostate gland on a television monitor, to aid the doctor in placement of the seeds. The seeds are then implanted into the prostate through very thin needles. Depending on different variables, between 50 and 100 seeds are used. The types of seed also vary and may include Iodine-125, Palladium-103, and echnogenic Iodine-125 seeds. The needles are inserted into the skin between the scrotum and rectum and are guided to the right place to most effectively treat the cancer. At the end of the procedure, a catheter will be placed in your bladder to help you pass urine during recovery.

How is the procedure performed ?

Permanent brachytherapy: 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.

Temporary brachytherapy: In temporary brachytherapy, a delivery device, such as a catheter, needle, or applicator, is placed into the tumor using fluoroscopy, ultrasound, MRI or CT to help position the radiation sources. The delivery device may be inserted into a body cavity such as the vagina or uterus (intracavitary brachytherapy) or applicators (usually needles or catheters) may be inserted into body tissues (interstitial brachytherapy).

Treatments may be delivered at a high dose-rate (HDR) or a low dose-rate (LDR). Treatment may also be delivered in periodic pulses (pulsed dose-rate or PDR).

High-dose rate (HDR) brachytherapy is usually an outpatient procedure although patients are sometimes admitted to the hospital to have several HDR treatments using the same applicator. With HDR brachytherapy, a specified dose of radiation is delivered to the tumor in a short burst using a remote-afterloading unit. The treatment lasts only a few minutes although the entire procedure (including placement of the delivery device) may take up to several hours. 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 10 separate HDR brachytherapy treatments over one or more weeks