HDR Brachytherapy

Overview

HDR Brachytherapy is a form of internal radiation therapy in which radiation-containing seeds, ribbons, or capsules are implanted in your body, in or near the tumor. Brachytherapy is a local treatment that only targets a specific area of your body. It is often used to treat head and neck cancer, breast cancer, cervical cancer, prostate cancer, and eye cancer.

When compared to the traditional kind of radiation therapy (external beam radiation), which projects radiation from a machine outside of the body, brachytherapy allows doctors to deliver higher doses of radiation to more targeted locations of the body.

Brachytherapy may have less adverse effects than external beam radiation, and the overall treatment period with brachytherapy is generally shorter.

When HDR Brachytherapy Is Required?

Doctors mainly use brachytherapy for cancer of the:

Brain
Breast
Cervical
Eye
Gallbladder
Head and neck
Lung
Prostate
Rectal
Skin
Thyroid
Uterine
Vaginal

They may also use it to treat tumors of the eye, back passage (rectum), penis, or breast.

Brachytherapy may be the only form of radiation available to you. It might also be treated with external radiation.

Types of Brachytherapy

There are three types of brachytherapy:

Low-dose rate (LDR) implants: The radiation source is left in situ for 1 to 7 days in this kind of brachytherapy. You will most likely be in the hospital at this period. Your doctor will remove the radiation source and the catheter or applicator once your treatment is complete.
High-dose rate (HDR) implants: The radiation source is only left in situ for 10 to 20 minutes at a time in this kind of brachytherapy. Treatment may be given twice a day for 2 to 5 days or once a week for 2 to 5 weeks. The timeline is determined on the sort of cancer you have. Your catheter or applicator may remain in place during therapy, or it may be removed before each session. You may be in the hospital throughout this period, or you could go to the hospital on a daily basis to have the radiation source installed. As with LDR implants, once you have completed treatment, your doctor will remove the catheter or applicator.
Permanent implants: The catheter is withdrawn once the radiation source has been installed. The implants will remain in your body for the rest of your life, but the radiation will gradually go away. Almost all of the radiation will disappear over time. When the radiation is first installed, you may need to restrict your time spent among other people and take extra precautions. Spend no time with children or pregnant ladies.

HDR Brachytherapy will Make You Give Off Radiation

The radiation source in your body will emit radiation for a short period of time during brachytherapy. If you receive a high dosage of radiation, you may need to take some precautions. Among these measures are:

Staying in a private hospital room to shield others from the radiation emitted by your body.
Being treated promptly by nurses and other healthcare personnel. They will offer all necessary care, but they may stand at a distance, converse with you via the doorway of your room, and wear protective clothes.

Your visitors will also need to adhere to safety precautions, which may include:

Not being allowed to visit when the radiation is first applied, needing to speak with hospital officials before they go to your room, standing at the doorway rather than entering your hospital room
Keeping visits to a minimum (30 minutes or less each day). The length of your sessions is determined by the type of radiation utilized and the area of your body being treated.
Pregnant women and children under the age of a year are not permitted to visit.

You may also need to take precautions after leaving the hospital, such as not spending too much time with other people. Your doctor or nurse will discuss any safety precautions you should take when you return home with you.

High-Dose-Rate vs. Low-Dose-Rate Brachytherapy

What you will feel during brachytherapy is determined on your individual treatment.

Radiation can be delivered in an one treatment session, as in high-dose-rate brachytherapy, or it can be delivered over time, as in low-dose-rate brachytherapy. The radiation source is sometimes permanently implanted in your body.

High-dose-rate brachytherapy

High-dose-rate brachytherapy is frequently performed as an outpatient surgery, which implies that each treatment session is quick and does not necessitate hospitalization.

High-dose-rate brachytherapy involves the placement of radioactive material in your body for a brief period of time, ranging from a few minutes to 20 minutes. You may get one or two sessions each day for a few days or weeks.

During high-dose-rate brachytherapy, you will lie in a comfortable position. The radiation device will be placed by your radiation treatment team. This might be as basic as a tube or tubes introduced into a body cavity or as little needles implanted into the tumor.

A computerized machine inserts the radioactive material into the brachytherapy device.

During your brachytherapy treatment, your radiation therapy staff will exit the room. They'll keep an eye on you from an adjacent room where they can see and hear you.

Brachytherapy should not be painful, but if you are uncomfortable or have any concerns, please notify your caregivers.

After the radioactive material has been removed from your body, you will no longer emit radiation or be radioactive. You are not a risk to others, and you can resume your normal activities.

Low-dose rate-brachytherapy

A continuous low dosage of radiation is released over time — from several hours to many days — during low-dose-rate brachytherapy. Typically, you will be admitted to the hospital while the radiation is administered.

Hands or machines are used to insert radioactive material into your body. Brachytherapy devices may be implanted during surgery, which may need anesthesia or sedation to keep you calm and decrease discomfort.

During low-dose-rate brachytherapy, you will most likely be kept in a private room in the hospital. Because the radioactive substance remains inside your body, there is a slight possibility it can cause harm to others. As a result, visitors will be restricted.

Children and pregnant women are not permitted to visit you in the hospital. Others may make a quick visit once or twice a day. Your health care team will continue to provide you with the necessary treatment, but they may limit the amount of time they spend in your room.

You should not experience any discomfort during low-dose-rate brachytherapy. It may be difficult to keep motionless and in your hospital room for several days. Inform your medical personnel if you have any discomfort.

The radioactive substance is cleared from your body after a set period of time. You are free to receive guests once your brachytherapy treatment is over.

Where Does HDR Brachytherapy Device Located?

Brachytherapy involves putting radioactive material near the malignancy into your body.

The location and extent of the cancer, your overall health, and your treatment goals all influence how your doctor distributes that radioactive material in your body.

The location might be inside a body cavity or in body tissue:

Radiation placed inside a body cavity. During intracavity brachytherapy, a radioactive material-containing device is inserted into a body opening, such as the windpipe or the vagina. The device might be a tube or cylinder that is custom-made to fit the exact body hole.

Your radiation therapy team may implant the brachytherapy device by hand or with the assistance of a computerized machine. To guarantee that the device is positioned in the most effective spot, imaging technology such as a CT scanner or ultrasound machine may be employed.
Radiation inserted into body tissue. Devices carrying radioactive material are implanted into body tissue, such as the breast or prostate, during interstitial brachytherapy. Wires, balloons, and small seeds the size of rice are among the devices used to deliver interstitial radiation into the treatment region.

The brachytherapy devices are inserted into body tissue using a variety of ways. Your radiation therapy team may employ needles or other specialized instruments. These long, hollow tubes are filled with brachytherapy devices like seeds and injected into the tissue to release the seeds.

Narrow tubes (catheters) may be implanted during surgery and afterwards filled with radioactive material during brachytherapy sessions in some situations.

CT scans, ultrasound or other imaging techniques may be used to guide the devices into place and to ensure they're positioned in the most-effective locations.

How To Prepare for HDR Brachytherapy?

Pre-surgical needs will be discussed with you by your healthcare practitioner. You might need to:

Get a magnetic resonance imaging (MRI) or computed tomography (CT) scan.
Stop taking any medications that alter blood clotting, such as blood thinners (warfarin) or nonsteroidal anti-inflammatory drugs (NSAIDs).
Before the surgery, do a bowel preparation (enema).
Before coming to the hospital, you should not drink or eat anything for many hours.

How HDR Brachytherapy Is Performed?

Prostate brachytherapy

You might be getting brachytherapy for prostate cancer. This entails inserting a radioactive source into the prostate. The radioactive source emits radiation that kills prostate cancer cells.

The source, also known as radioactive seeds, may remain inside your prostate indefinitely (low dose rate brachytherapy). Over the course of several months, the radiation is gradually released.

Alternatively, you might receive a larger dosage of radiation in which the radioactive source remains inside the prostate for 15 to 40 minutes (high dose rate brachytherapy). Your radiographers then remove the source, leaving no radiation within your body.

Brachytherapy to the cervix, womb or vagina

Brachytherapy may be used to treat cancers of the cervix, womb, or vagina.

Under general anaesthesia, your doctor inserts hollow tubes (applicators) into the vagina to the site of the tumor. The tubes are connected to a brachytherapy machine. The radioactive source travels from the machine to the malignancy via the tubes.

The radioactive source might remain within your body for 10 to 20 minutes. The source is returned to the machine after treatment. You might receive numerous treatments. This therapy is available as an inpatient or outpatient.

Brachytherapy for other cancer types

There are some different types of brachytherapy for other cancer types.

A tiny radioactive metal disc is put over the malignancy on the eye in the case of eye cancer. This disc is known as a plaque. The plaque emits radiation continuously while in situ and treats a tiny region. This therapy is administered as an inpatient over a period of 2 to 7 days.

Breast brachytherapy may necessitate a few days in the hospital. Thin hollow tubes or a tiny balloon are inserted into your breast. The tubes or balloon are connected to the brachytherapy machine by your radiographers.

A radioactive pellet is released from the machine and travels through the tubes or balloon to treat the surrounding environment. The radioactive source remains in situ for a few days, or for a few minutes once or twice a day.

For intestinal cancer that has progressed to the liver, doctors may employ a kind of brachytherapy known as selective internal radiation treatment (SIRT). They insert small radioactive beads into a blood vessel (artery) that leads to your liver. The beads become lodged in the tumour's tiny blood arteries, and the radiation kills the cancer cells. Although the beads remain in place indefinitely, the radiation is released over a period of many weeks.

The radiation range of the beads is quite limited. However, you may be advised to avoid close contact with young children and pregnant women for the first week or two following treatment as a precaution. In addition, your doctor may urge you not to share a bed with your spouse for the first night or two.

How Long Does the Implant Stay In the Body?

Implants can be either temporary or permanent. If the implants are to be removed but subsequently replaced, the catheter is frequently kept in place until the therapy is completed. When the implants are removed for the last time, the catheter is withdrawn. The method of brachytherapy you will receive is determined by a variety of criteria, including the location of the tumor, the stage of the malignancy, and your overall health.

How long does the brachytherapy radiation stay in the body?

Following treatment, your body may emit a small quantity of radiation for a brief period of time. If the radiation is contained in a temporary implant, you will be required to remain in the hospital and may be restricted from interacting with visitors. Children and pregnant women may not be permitted to visit you. Your body will no longer emit radiation when the implant is removed.

Permanent implants emit modest quantities of radiation over a few weeks to months before gradually ceasing to emit radiation. Because radiation does not normally spread far, the possibility of others being exposed to radiation is relatively low. However, you may be requested to take measures such as avoiding young children and pregnant women, especially immediately following treatment.

Complications & Side Effects

Common short-term side effects of brachytherapy

Some brachytherapy adverse effects occur during or shortly after treatment and normally improve after approximately 2 weeks. If you are undergoing brachytherapy following chemotherapy and radiotherapy (chemoradiation), you may already be fatigued and ill, so knowing what more to expect may be helpful.

The most common short-term side effects of brachytherapy are given below.

1. Sore skin in the treatment area

The inside and outside of your genitals (vulva) and the area surrounding your bottom may be painful. Using a moisturizer on the outside of the body every day can assist.

While you are having radiotherapy, do not:

Shave.
Wax.
Use hair removal cream.

Wait until your radiation is ended and your skin is no longer red or irritated before using these items.

For at least the first year following radiation, take particular precautions to protect the skin in the treated region. Use high factor sunscreen and avoid using sunbeds if part or all of your body will be exposed, such as if you are wearing a bikini.

When you pee, the irritated skin may cause pain (stinging). Inform your healthcare team as soon as possible about your symptoms so that they can assist you.

2. Feeling very tired (fatigue)

Brachytherapy might leave you exhausted and physically weak. This is referred to as fatigue. It is not the same as normal tiredness in that you may feel exhausted after doing nothing. This is merely your body's response to the treatment, as it attempts to restore any healthy cells harmed by brachytherapy.

Fatigue may persist only a few days or weeks following therapy, but it might continue months. Speak with your healthcare team if you are feeling tired; they may be able to provide some remedies. Our community has provided the following suggestions:

Getting moving – gentle exercise like a walk or yoga can help
Getting some fresh air – even if it’s sitting by an open window.

3. Bowel changes

Brachytherapy may cause you to have runny poo (diarrhea) or the need to use the bathroom quickly. This might begin approximately a week into therapy. You may also get stomach pains and wind (gas).

Inform your healthcare provider if you notice any of these changes or if you have any additional gastrointestinal issues. They might be able to make some suggestions.

4. Bladder changes

Brachytherapy might make you feel like you need to pee more frequently or urgently. When you urinate, you may experience stinging or scorching sensation. This is because the applicators and radiation can cause bruising and harm to the area where you got the therapy.

You may also see some blood in your wee for a few days after treatment has finished. Tell your healthcare team straight away if you:

Notice heavy bleeding.
Have blood clots in your urine.
Have a fever.

Inform your healthcare provider if you notice any of these changes or if you have any additional bladder issues. If you have a urinary tract infection (UTI), they may be able to give medications or advise alternative treatments.

5. Pain

You may experience discomfort between your hipbones (pelvis) or in your lower back following brachytherapy. This might be because the radiation induced intestinal changes, which could cause stomach cramps, or because it injured the bones.

It is critical to inform your healthcare staff of any discomfort you are experiencing. They can examine the situation and assist in determining the source of the discomfort.

6. Changes to your vagina

Your vagina may become tighter, shorter, and drier throughout therapy. This is known as vaginal stenosis. It can make intercourse and internal vaginal exams uncomfortable.

To assist avoid vaginal stenosis, your healthcare provider should provide you with vaginal dilators. A dilator is a smooth plastic, rubber, or silicone tube. Dilators are little devices that are put within the vagina to keep it open. More information on how to utilize them should be provided by your healthcare team. It is possible that you will be encouraged to begin using dilators 2 to 8 weeks following radiation, but you should wait until your vagina is no longer painful.

There isn't enough data to establish if vaginal dilators improve sex after brachytherapy, although some women find them useful and specialists encourage them.

Lubrication can aid in the relief of vaginal dryness. These are often liquids, gels, or creams that may be purchased at pharmacies, online, or for free with a prescription. If you believe a lubricant may be beneficial, consult with your healthcare staff.

After brachytherapy, you may develop vaginal bleeding. The procedure has the potential to weaken the vaginal walls, bringing blood vessels closer to the surface. This region might bleed if it is inflamed. The bleeding should be minimal.

Long-term effects of brachytherapy

Brachytherapy can have a long-term impact on your body and day-to-day life. It can cause effects that start or last for months or years after treatment. In some cases, these effects can last for the rest of your life.

You may hear these effects called pelvic radiation disease or PRD. They can include:

Early menopause .
Bladder and bowel problems.
Changes to your vagina.
Changes to your sex life.
Swelling in your groin or legs (lymphoedema).
Bone problems.
Pain.
Nerve damage.

Conclusion

HDR Brachytherapy is a type of internal radiotherapy. A small radioactive material called a source is put into your body, inside or close to cancer. Or into the area where cancer used to be before having surgery.

There are different types of radioactive sources (also called implants) such as seeds, wires or discs. They deliver radiotherapy to the area, destroying the cancer cells. Healthy tissue near to cancer gets a lot less radiation.

Your doctor works out how much radiation you need. This affects how long the radioactive source stays inside you for. This can be anything from several minutes to a few days or can stay in place permanently. If the source stays inside you permanently, it stops giving off radiation after a few weeks or months.