Brachytherapy for cancer: What to expect during internal radiation

About half of all people treated for cancer receive some form of radiation therapy — the use of high-powered radiation to kill cancer cells. The majority of people receive radiation therapy from a machine outside of their body, a treatment called external beam radiation therapy. But a different type of radiation therapy called brachytherapy allows doctors to place radioactive material inside your body.

Brachytherapy delivers higher doses of radiation to more-specific areas of the body, compared with the conventional form of external beam radiation therapy. Brachytherapy may cause fewer side effects, and the treatment time is usually shorter.

Who is brachytherapy for?

Brachytherapy is used to treat several types of cancer, including:

• Breast cancer
• Cervical cancer
• Endometrial cancer
• Gallbladder cancer
• Head and neck cancers
• Lung cancer
• Prostate cancer
• Vaginal cancer

Brachytherapy is sometimes used to treat noncancerous conditions, including benign tumors and coronary artery disease.

Brachytherapy can be used alone or in conjunction with other cancer treatments. For instance, brachytherapy is sometimes used after surgery to destroy any cancer cells that may remain. Brachytherapy can also be used along with external beam radiation.

How do you prepare for brachytherapy?

Before you begin brachytherapy, you may meet with a doctor who specializes in treating cancer with radiation (radiation oncologist). You may also undergo scans to help your doctor determine your treatment plan. Procedures such as X-rays or computerized tomography (CT) may be performed before brachytherapy.

How is brachytherapy done?

Brachytherapy treatment involves inserting radioactive material into your body near the cancer or in the area where the cancer once was. How your doctor places that radioactive material into your body depends on many factors, including the location and extent of the cancer, your overall health and your treatment goals.

Radiation placed inside a body cavity
During intracavity brachytherapy, a device containing radioactive material is placed in a body opening, such as the windpipe or the vagina. The device may be a tube or cylinder made to fit the specific body opening.

Your radiation therapy team may place the brachytherapy device by hand or may use a computerized machine to help place the device. Imaging equipment, such as a CT scanner or ultrasound machine may be used to ensure the device is placed in the most effective location.

Radiation inserted into body tissue
During interstitial brachytherapy, devices containing radioactive material are placed within body tissue, such as within the breast or prostate. Devices that deliver interstitial radiation into the treatment area include wires, balloons and tiny seeds the size of grains of rice.

A number of techniques are used for inserting the brachytherapy devices into body tissue. Your radiation therapy team may use needles or special applicators. These long, hollow tubes are loaded with the brachytherapy devices, such as seeds, and inserted into the tissue where the seeds are released. In some cases, narrow tubes (catheters) may be placed during surgery and later filled with radioactive material during brachytherapy sessions. CT scans, ultrasound or other imaging techniques may be used to guide the devices into place and to ensure they're positioned in the more effective locations.

Intracavity brachytherapy

Intracavity brachytherapy

During intracavity brachytherapy, an applicator containing a radioactive substance is placed within the body, at or near the site where the tumor is located or was removed.

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Interstitial brachytherapy

Interstitial brachytherapy

During interstitial brachytherapy, devices containing radioactive material are inserted directly into body tissue. One treatment for prostate cancer involves placing radioactive seeds into the prostate.

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What can you expect during brachytherapy?

What you'll experience during brachytherapy depends on your specific treatment. Radiation can be given in a brief treatment session, as with high-dose brachytherapy, or it can be left in place over a period of time, as with low-dose brachytherapy. Sometimes the radiation source is placed in your body permanently.

High-dose brachytherapy
High-dose brachytherapy is usually an outpatient procedure, which means each treatment session is brief and doesn't require that you be admitted to the hospital. During high-dose brachytherapy, radioactive material is placed in your body for a short period — from a few minutes up to 20 minutes. You may undergo high-dose brachytherapy just once. Or you may undergo one or two sessions a day over a number of days or weeks.

You'll lie in a comfortable position during high-dose brachytherapy. Your radiation therapy team will position the radiation device, in the case of intracavity brachytherapy, or your radiation device may already be in place if you're having interstitial brachytherapy. The radioactive material is inserted into the brachytherapy device by hand or with the help of a computerized machine.

Your radiation therapy team may leave the room during your brachytherapy session. They'll be observing from a nearby room where they can see and hear you. You shouldn't feel any pain during brachytherapy, but if you feel uncomfortable or have any concerns speak up. Expect the entire treatment session to last about an hour.

Once the radioactive material is removed from your body, you won't give off radiation or be radioactive. You aren't a danger to other people, and you can go on with your usual activities.

Low-dose brachytherapy
During low-dose brachytherapy, a continuous low dose of radiation is released over time — from several hours to several days. You'll stay in the hospital while the radiation is in place.

Radioactive material is placed in your body by hand or by machine. Brachytherapy devices may be positioned during surgery, which may require anesthesia or sedation to help you remain still during the procedure and to reduce any discomfort.

You'll likely stay in a private room in the hospital during low-dose brachytherapy. Because the radioactive material stays inside your body, there is a small chance it could harm other people. For this reason, visitors may be restricted. Children and pregnant women shouldn't visit you in the hospital. Others may visit briefly once a day or so. Your health care team will still give you the care you need, but may restrict the amount of time they spend in your room.

You shouldn't feel pain during low-dose brachytherapy. Keeping still and remaining in your hospital room for days may be uncomfortable. If you feel any discomfort, tell your health care team.

After a designated amount of time, the radioactive material is removed from your body. You're free to have visitors without restrictions once the brachytherapy treatment is completed.

Permanent brachytherapy
In some cases, such as with prostate cancer brachytherapy, radioactive material is placed in your body permanently. The radioactive material may be placed by hand or with the help of a computerized machine. You may feel pain during the placement of radioactive material, but you shouldn't feel any discomfort once it's in place.

Your body will emit low doses of radiation from the area being treated at first. Usually the risk to others is minimal and may not require any restrictions about who can be near you. In some cases, for a short period of time you may be asked to limit the length and frequency of visits with pregnant women or with children. The amount of radiation in your body will diminish with time, and restrictions will be lifted.

Results

Your doctor may recommend scans after brachytherapy to determine whether treatment was successful. What types of scans you undergo will depend on the type and location of your cancer.

Risks

Side effects of brachytherapy are specific to the area being treated. Because brachytherapy focuses radiation in a small area, only that area will be affected. You may experience tenderness and swelling in the treatment area. Ask your doctor what other side effects can be expected from your specific treatment.

Looking ahead

Researchers are testing brachytherapy in a number of cancer types. Because this type of treatment focuses radiation on a smaller area, it may offer similar benefits to external radiation with fewer side effects. However, for most cancers, more study is needed to determine if brachytherapy is a viable treatment option.

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