Brachytherapy - An Overview

Introduction

Brachytherapy is also known as internal radiation therapy and is used to treat prostate, breast, cervix, head, and neck cancer. The human body comprises thousands of cells that divide rapidly and help in the growth of the body. Cancer occurs due to the uncontrolled division of the cells. If the cells remain confined to the organ, they are considered benign. On the contrary, if the cells spread to the other organs, they are said to be malignant or cancerous. There are genes present in the body that stimulate and inhibit the growth of cells. When the genes that prevent cell growth fail to function, or are defective, the growth of the cells increases resulting in tumors or cancer. It is because there is no one to stop the genes that allow cell growth. However, there are treatment options available to kill the defective cells or slow down their growth, brachytherapy being one of them. It is a procedure in which a special material is placed into the body to destroy the cells and slow down their growth.

Is Brachytherapy Similar to External Radiation Therapy?

The other name for brachytherapy is internal radiation therapy. It is completely different from external radiation therapy. In brachytherapy, the surgeon places radioactive material in the body to kill the cancer cells. Therefore, the radiation is received by only the organ or the area affected by cancer. Whereas in external radiation therapy, a machine is used to deliver the radiation to the tumor or cancer. As the radiation passes through the skin, there is a chance that the other healthy organs also receive it and get damaged. The side effects of brachytherapy are less compared to external radiation therapy.

What Are the Different Types of Brachytherapy?

Brachytherapy implants are classified according to the time up to which they remain in the body. The different types of brachytherapy implants have been described in the table below:

Why Is Brachytherapy Done?

Brachytherapy aims to release radiation and kill the cells showing uncontrolled growth. It is used to treat cancer of the following organs:

• Brain cancer.

• Liver cancer (mainly bile duct cancer).

• Breast cancer.

• Cervical cancer.

• Lung cancer.

• Skin cancer.

• Endometrial cancer.

• Eye cancer.

• Head and neck cancers.

• Pancreatic cancer.

• Prostate cancer.

• Vaginal cancer.

• Rectal cancer.

• Esophageal cancer.

What Are the Benefits of Brachytherapy?

Brachytherapy is a commonly used procedure to treat cancer. The advantages of brachytherapy are listed below:

1. It is one of the most effective treatments as the radiation is delivered directly to the organ affected by cancer.

2. The healthy cells of the body are not damaged, so the side effects are minimal.

3. The patient need not stay in the hospital for long, unlike other procedures.

4. The time required to complete the procedure is short, lasting from a few minutes to five days.

5. The patient need not visit the hospital repeatedly after the procedure.

6. The recovery is completed in five to seven days so that the patient can return to his job quickly.

How Does the Patient Prepare for Brachytherapy?

Brachytherapy is a procedure used to treat cancer in the body's internal organs. The following things are done before brachytherapy:

• The doctor explains the procedure as a whole. If the patient is willing to undergo the same, he must sign a consent form.

• The patient should also inform the doctor about his medications or any allergies or disorders he suffers from. For example, the doctor might ask the patient to stop taking drugs like Aspirin and Ibuprofen before the procedure, as they can cause excessive bleeding.

• A medication known as a laxative is usually given before the procedure to allow bowel movement.

• The patient should not eat anything a few hours before the surgery.

• The doctor might ask the patient to undergo the following imaging test before the procedure to get an idea about the exact location and spread of the cancer:

  1. Computerized Tomography (CT) Scans - In this procedure, the patient is laid on his back on a table that slips into a tunnel-like cylindrical device where the X-rays are taken. It is one of the most commonly used diagnostic methods because it provides three-dimensional (3D) images of the organs affected by cancer.

• Before the commencement of the procedure, anesthesia will be administered to the patient so that he falls asleep and the procedure is carried out smoothly without any pain or inconvenience.

What Happens in Brachytherapy?

The procedure depends upon the type of brachytherapy and cancer. A small tube, known as a catheter, might be inserted to place the radioactive material in the body. The material can also be placed with a device known as the applicator. The different techniques for placing brachytherapy include:

• Interstitial Brachytherapy - In this procedure, a device or applicator containing the radioactive material is placed into the body tissues. This technique is mainly used for breast and prostate cancer. The devices that deliver the radiation to the body tissues are balloons, wires, and seeds that are small as a rice grain. The device is placed by hand or with the help of a computerized machine. It can remain in place for one to seven days if the patient is undergoing low-dose brachytherapy. On the contrary, The device remains in place for 15 to 20 minutes if the patient undergoes high-dose therapy.

• Intracavitary Brachytherapy - As the name suggests, the applicator or the device that contains the radioactive material is placed into the body cavities. For example, the radioactive device can be placed in the vagina to treat cervical cancer or in the trachea (windpipe) to treat lung cancer. The device that delivers the radiation is like a tube that fits into the cavities of the body. It can be placed by hand, a computerized machine, or a catheter. The tube placed at the time of surgery, known as a catheter, can be filled with radioactive material each time. The radioactive device remains in the body for a few minutes, days, or permanently depending upon the type of brachytherapy and cancer.

• Episcleral Brachytherapy - It is a procedure used to treat eye melanoma and retinoblastoma. Melanoma occurs in the eyes when the cells producing melanin pigments are damaged due to cancer. Retinoblastoma is also a type of eye cancer wherein the cells forming the retina are damaged. In episcleral brachytherapy, the radiation device is attached to the eye to treat eye cancer.

What Happens After Brachytherapy?

After the treatment, the patient is taken to the recovery room to allow the anesthesia to wear off. If the patient has undergone high-dose brachytherapy, the catheter or the applicator is removed, and the patient does not emit any radiation. However, the following things need to be kept in mind after the procedure:

1. The doctor will prescribe painkillers after removing the catheter.

2. If the patient has undergone permanent or low-dose brachytherapy, the applicator remains in place for a few days or permanently.

3. The patient will be emitting radiation, so he needs to stay away from people, especially children and pregnant women.

4. The doctor or the nurse will treat and provide all the care to the patient but from a distance because of the radiation device attached to the body.

5. Friends and relatives will not be allowed to meet the patient because of the risk of radiation exposure.

6. The patient is allowed to meet someone only for half an hour and from a distance.

7. Consult the doctor before going to work or doing other activities.

8. The patient must immediately report to the doctor if he experiences the following:

   • Diarrhea.

   • Urine leakage.

   • Respiratory difficulties.

   • Vomiting and loss of appetite.

   • Stomach problems.

What Are the Complications of Brachytherapy?

The complications depend upon the type of brachytherapy and cancer that has been treated. The complications of brachytherapy are listed below:

• The patient might leak urine (urinary incontinence) before reaching the toilet if he has been treated for prostate cancer.

• The presence of pain and burning sensation while urinating are commonly seen.

• The radiation might damage the nerves and blood vessels of the pelvis and cause erectile dysfunction. The penis cannot remain erect as the blood supply has been blocked due to radiation.

• Brachytherapy also causes stomach problems like diarrhea, pain, and gas in the stomach.

• If brachytherapy has been used to treat cervical, vaginal, or prostate cancers, bowel movements get affected, and the patient might suffer from constipation.

• The patient might experience hair loss if he has been treated for head and neck cancer.

• The radiation might destroy the healthy cells of the mouth, causing ulcers and mouth sores.

• The patient feels tired throughout the day and cannot eat anything due to stomach problems.

• If brachytherapy has been done to treat lung cancer, shortness of breath is one of the most common complications.

Conclusion

Brachytherapy is used to treat cancer in multiple body organs. When the cells present in the body proliferate rapidly, cancer occurs. There are many options available to treat cancer, but brachytherapy has become a choice of the doctors and the patient. It is because the procedure is minimally invasive, the healing is quick, and the radiation emitted from the device only targets the defective cells, not the healthy ones. It has been commonly seen that people lose hope when they are diagnosed with cancer. Brachytherapy is a boon for such patients because it saves them from long hospital stays and strong drugs that cause side effects. The devices used for brachytherapy are designed in such a way that they deliver radiation only to the organ affected by cancer. Hence, the healthy tissues of the body are saved from getting damaged. Therefore, the patient must not lose hope and consult the doctor immediately if he is diagnosed with cancer. Brachytherapy is a simple procedure with great results and minimal side effects.