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Brachytherapy is USFDA approved advanced radiation treatment for cancer in which radioactive source is placed in the form of seeds,wires and ribbons directly into or near the cancerous tissue.It is also known as an internal radiation therapy by which tumor is targeted with high dose of radiation that kills cancer cells by damaging their DNA. As a consequence the tumor shrinks in size since the cells now stop dividing and eventually die. The good part of the brachytherapy is that the surrounding healthy tissue is spared to a large extent. The term "Brachy" has been derived from a Greek word that means"Short distance". Brachytherapy may be used alone or in combination with other cancer treatment modalities for best outcome.
Q1 What type of cancers are usually treated by Brachytherapy?
A1. Brachytherapy can be used to treat the following types of cancers.
Q2 What is temporary Brachytherapy? How is it different from permanent Brachytherapy?
A2 Temporary Brachytherapy is a source of high dose radioactive material to treat cancer.
A delivery device such as the bronchoscope is put inside the body to get as near the cancer as feasible to deliver high dose radiation to the affected area for several minutes. Once the treatment is done, the radiation source would be taken out.
Permanent Brachytherapy is a source of continuous low dose radiation.
Radioactive seeds are implanted in your body directly inside or near the tumor and they give out continuous radiation of low dose. The seeds will gradually get weak and stop giving out radiation. It is also called Seed Implantation and seeds are that of the size of grains of rice.
Q3 What are the advantages of Brachytherapy?
A3. The several advantages that Brachytherapy can offer to the patient are:
Q4 What is the role of Brachytherapy in Breast Cancer Treatment?
A4 Brachytherapy offers hope to many patients with Early Stage Breast Cancer. It is an advanced form of radiation therapy, an effective alternative to Conventional Whole Breast External Beam Radiation Therapy. Radiation therapy is usually recommended after lumpectomy for treatment of Early Stage Breast Cancer and lower the risk of cancer's recurrence. Brachytherapy is also referred to as Accelerated Partial Breast Irradiation (APBI). As compared to the Conventional Whole Breast External Beam Radiation Therapy, Brachytherapy involves delivery of high dose radiation from within, to a small region of breast for a short period of time.
Q5 Am I the right candidate for Brachytherapy for Breast Cancer Treatment?
A5 Every woman with breast cancer is not the suitable candidate for Brachytherapy. Some women may need conventional whole breast radiation instead. However, the decision of the most appropriate treatment protocol for you will be determined by your team of specialists after taking into account the characteristics of your breast cancer.
Conventional EBRT(External Beam Radiation Therapy), as the name implies, involves radiation given from source placed outside the breast. It causes destruction of the cancer cells by radiating either the whole breast or the target area where the tumor was.
The following general guidelines have been laid down to evaluate patient's eligibility for Brachytherapy as an option for treating breast cancer. They can be summarized as follows:
Invasive breast cancer or DCIS(Ductal carcinoma in Situ) diagnosis with a size equal to or smaller than 3cm.
Clean surgical margins, 1mm at least
Breast cancer with single centre of origin(Unicentric)
Negative lymph node or at the most 3 positive lymph nodes in the armpit region and with no penetration of the capsule of the lymph node by the tumor.
Maximum 6 weeks interval from Lumpectomy surgery or Breast USG and CT scan evidence showing clear lumpectomy cavity edge.
This is for information purpose only. Your specialist is the best person to advise you on the best treatment protocol for you specially customized as per your needs.
Q6 What are the disadvantages of conventional External Beam Radiation Therapy to breast as compared to Brachytherapy?
A6 The disadvantages of Conventional EBRT as compared to Brachytherapy treatment for breast cancer can be summarized as follows:
Inconvenience to the patient and her family- Traditional radiation therapy involves daily visit to the hospital for usually 5 days a week for nearly 4 to 6 weeks, which is cumbersome.
Large area of work- Conventional radiation therapy generally expose large area to the harmful effects of radiation compromising the safety of heart and lungs.
Q7 What are the different types of Brachytherapy used for treating breast cancer?
A7 Brachytherapy for Breast Cancer treatment is an advanced radiation treatment for breast cancer, wherein the radiation source is placed inside the breast. It is of three types. Out of three types, only two types are currently in use and third one is still experimental.
Interstitial Needle-Catheter Brachytherapy, also referred to as Multi catheter Internal Radiation
It involves the use of Radioactive seeds to deliver radiation directly to the cancer affected area of the breast. The seeds are placed in tiny tubes known as catheters. The catheters are then put into place and stitched under the skin for the duration of the treatment in the hospital, which may last for few hours or few days. Once the treatment is over, the seeds, catheters and the stitches are taken out and the patient is discharged.
Balloon Internal Radiation
This type involves the placement of the special tube with a balloon at one end, in the cancer affected area of the breast. The other end comes out of the skin through a hole. This tube is placed during the Lumpectomy surgery or afterwards at the specialist's office. Each treatment session involves placing a radioactive seed in the centre of the balloon through a machine, for 5 to 10 minutes, or long enough to deliver requisite radiation to the cancer affected area of concern. Patient is discharged from the hospital after the seed is removed. 10 treatment sessions are usually carried out over a span of 5 days. That makes 2 treatment sessions per day, generally 6 hrs apart. Once the final treatment is over, the tube and the balloon are taken out through the small hole in the skin.
3-D conformal External Beam Radiation (3-D CRT)
This experimental method involves planning session wherein a special MRI/CAT scan of the breast is carried out in order to elicit those small treatment areas of the breast that are at risk. The goal of the therapy is to maximize the delivery dosage of the radiation to the target area while protecting the surrounding healthy tissue at the same time from harmful effects of the radiation. The type and distribution of the radiation is taken into account while planning the therapy to meet the above goal. Linear accelerator machine, the machine that is used for external beam radiation therapy, is utilized to deliver radiation twice a day for around 1 week.
Q8 How does Brachytherapy work?
A8 Brachytherapy involves the placement of the source of radiation in or near the cancerous tissue. Brachytherapy, this word is derived from Greek Word, "Brachy", which means "Short distance" and "Therapy"that implies Treatment. Hence, Brachytherapy implies, treatment from a short distance.
Brachytherapy works on the laws of physics according to which the radiation intensity is the maximum near the source of radiation eg. Radioactive seeds and the more the distance from the radioactive source, the intensity of the radiation diminishes significantly. This places Brachytherapy at an advantageous position over External Beam Radiation Therapy because it spares the surrounding healthy tissues such as heart, lungs, skin, ribs from harmful effects of radiation. Thousands of patients suffering from Breast cancer have reaped its benefits over conventional External Beam radiation Therapy and found it to be a safe and effective alternative for breast cancer treatment. Although the overall patient survival in both cases is similar yet the convenience and compliance is better in Brachytherapy. Brachytherapy has a shorter course of treatment , usually 5 days as compared to 6 to 7 weeks of daily radiation therapy in case of External Beam Radiation Therapy.
Q9 Are there any side effects of Brachytherapy?
A9 Yes, Brachytherapy may be associated with side effects, though less intense. The type of side effects that the patient may experience vary according to the type of cancer, location of cancer and the site of the Brachytherapy source in the body. However, they usually last for few days after the treatment is over. Some of them are generally due to the instruments used during the procedure and some due to the radiation being released from the radioactive implants and vanish once the radiation source loses its radiation strength with time. These side effects are short term, normal and are not a cause of concern.
They can be summarized as below:
Pain or discomfort at the place of implant.
Urinary symptoms such as frequent, urgent, painful urination,urinary retention, blood in the urine and other symptoms such as diarrhea, constipation and rectal bleeding if the Brachytherapy is being used for Gynecological(cervical, uterine or vaginal) or prostate cancer.
Discoloration of semen
There are certain side effects, though rare, that call for immediate attention of the specialist and they are: infection due to implantation of radioactive seed , severe bleeding or pain and passing blood clots in urine.
It is always recommended that you discuss your concern with your specialist and weigh pros and cons of your treatment options and make an informed decision. Also, please stick to your specialist's instructions and clear all your doubts to understand the therapy and its effects on your body.
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Dr Tejinder Kataria
MBBS,MD (Radiotherapy),DNB (Radiotherapy)
CCST (Clinical Oncology), British Institute of Radiology (UK)
FIMSA, International Medical Science Academy
Commonwealth Scholar, British Council
Chairperson, Radiation Oncology
Medanta,The Medicity,Gurgaon, Delhi, NCR
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