Brachytherapy is a cancer treatment in which radioactive material sealed inside a seed, pellet, wire, or capsule is implanted in the body using a needle or catheter. The radiation given off by this source damages the DNA of nearby cancer cells.
Brachytherapy is most commonly used to treat prostate cancer. It also can be used for gynecologic cancers such as cervical cancer and uterine (endometrial) cancer, as well as breast cancer, lung cancer, rectal cancer, eye cancer, and skin cancer.
Here are answers to some of the common questions our brachytherapy experts hear from patients.
- What are the benefits of brachytherapy?
- How long does the implant stay in the body?
- How is brachytherapy delivered?
- How do doctors know if the radioactive material is going to the right place?
- Does brachytherapy require a hospital stay?
- What’s the difference between low dose rate brachytherapy and high dose rate brachytherapy?
- How does brachytherapy compare with other forms of radiation treatments?
- How often is brachytherapy treatment given, and how long do the sessions last?
- How long does the brachytherapy radiation stay in the body?
- What side effects may occur as a result of brachytherapy?
- Why choose Memorial Sloan Kettering for brachytherapy?
Using an implant allows a higher dose of radiation in a limited area than might be possible with conventional radiation treatments that are delivered externally. This can be more effective at destroying the cancer cells while minimizing damage to surrounding normal tissue.
The implants may be temporary or permanent. If the implants will be removed but then put in again later, the catheter is often left in until the treatment is finished. The catheter is then removed when the implants are taken out for the last time. The way you will receive brachytherapy depends on a number of factors, including where the tumor is, the stage of the cancer, and your overall health.
In most brachytherapy procedures, a doctor who specializes in radiation therapy, called a radiation oncologist, uses a needle or catheter to place the encapsulated radioactive material inside the body directly on or near a tumor. In some cases, the radioactive material is placed in a body cavity, such as the rectum, vagina, or uterus. The patient is sedated for all of these procedures.
Radiation oncologists rely on imaging techniques such as CT scans and ultrasound during brachytherapy planning and delivery to ensure that the encapsulated material is placed with precision.
It depends on the cancer you have and the kind of brachytherapy that you receive: Low Dose Rate (LDR) or High Dose Rate (HDR). LDR brachytherapy typically does not require an overnight stay in the hospital. HDR brachytherapy may require you to stay in the hospital.
With low dose rate (LDR) brachytherapy, doctors insert tiny seeds containing radiation in or near the tumor while the patient is under anesthesia. LDR brachytherapy typically takes a little over an hour and does not require an overnight stay in the hospital. Usually the seeds are permanent, but they cause little or no discomfort, and their radioactivity lessens after several weeks or a few months. In some cases, such as the treatment of eye tumors, the implants are removed after several days.
In high dose rate (HDR) brachytherapy, doctors typically give concentrated bursts of radiation in a short amount of time. With the patient under anesthesia, a number of plastic catheters (tubes) are inserted into or near the tumor. The catheters are attached to a machine that contains precise doses of radiation in the form of radioactive pellets. For skin cancer, HDR brachytherapy uses electronically produced radiation that is given at the skin surface without need for catheters.
When used appropriately, brachytherapy has been shown to be as effective as conventional external beam radiation therapy and surgery for many cancers. It is best used in patients whose cancer has not spread, or metastasized. In many cases, brachytherapy is combined with external-beam radiation therapy, including stereotactic body radiation therapy, to get the best results.
For LDR brachytherapy, the radiation sources have to remain within or next to the cancer for an extended period of time. Because of this, treatment is usually spread out over the course of one week and requires a stay in the hospital.
For HDR brachytherapy, the treatment is given in one or two brief (around 15 minute) sessions, delivering radiation directly to the tumor. After the final treatment, the catheters are removed and you can return home.
After treatment, your body may give off a small amount of radiation for a short time. If the radiation is contained in a temporary implant, you’ll be asked to stay in the hospital and may have to limit your interactions with visitors. Pregnant women and children may not be allowed to visit you. Once the implant is removed, your body will no longer give off radiation.
Permanent implants give off small doses of radiation over a few weeks to months as they slowly stop giving off radiation. The radiation doesn’t usually travel far, so the chance that others could be exposed to radiation is very small. Still, you may be asked to take precautions such as staying away from small children and pregnant women, especially right after treatment.
Side effects of brachytherapy can include swelling, bruising, bleeding, or pain and discomfort at the spot where the radiation was delivered. Brachytherapy used for gynecologic cancers or prostate cancer can lead to short-term urinary symptoms, including incontinence or pain on urination. Brachytherapy for these cancers can also lead to diarrhea, constipation and some rectal bleeding. Prostate brachytherapy can occasionally cause erectile dysfunction.
Memorial Sloan Kettering has long been a leader in brachytherapy, pioneering many advances in the field. In fact, MSK doctors were the first to use brachytherapy to treat cancers in the early 20th century.
That expertise continues today, as our medical physicists work with radiation oncologists to design the safest, most precise way to administer the brachytherapy using mathematical modeling and advanced computer programs. Through this collaboration, MSK specialists have developed highly specialized brachytherapy methods for specific diseases.
We also have the only state-of-the-art intraoperative imaging suite in the country dedicated solely to brachytherapy procedures. One unique feature of the suite is a portable CT unit called the O-Arm, which provides real-time snapshots to confirm the accuracy of brachytherapy placement during the procedure. This approach allows our doctors to ensure that seeds or pellets were placed at the ideal locations, which increases the treatment’s effectiveness and reduces the side effects of damage to healthy tissue.
For prostate cancer, our expert team developed a patent-pending computer program that helps the radiation oncologists map out the actual dose delivered to the prostate so they can make adjustments to ensure the most optimal delivery and quality of treatment.
Our use of sophisticated real-time imaging techniques are unmatched and enables us to have very high success rates. For example, our use of LDR brachytherapy to treat prostate cancer is successful in eliminating the cancer in 95 percent of cases.