Internal and External Radiation Therapy
Radiation therapy, in general, uses high-energy radiation to shrink tumors and kill cancer cells. Currently, two different types of radiation therapy are available to treat various types of cancer:
- External – Radiation delivered outside of the body (i.e., x-rays and gamma rays); and
- Internal – Radiation delivered inside the body, called “brachytherapy.”
High-Tech Internal Radiation Therapy – Brachytherapy
In the advanced, high-tech cancer treatment option of internal radiation therapy, called brachytherapy, your doctor can use a higher total dose of radiation to treat a smaller area in less time and with more precision than with external beam radiation therapy. This reduces radiation exposure to surrounding healthy tissue or tissues that could be very sensitive to radiation.
Small “seeds” are placed inside the patient on a temporary or permanent basis through a device that consists of flexible, very thin tubes that allow the seeds to be placed in the body very precisely.
The radiation seeds may break down on their own, or in some cases, the patient may need to return to the doctor to have the device removed that delivered the high-dose radiation seeds. Brachytherapy can be used alone or in conjunction with external beam radiation. Your oncology team will advise of the most appropriate cancer treatment program for you.
Types of Brachytherapy
The type of brachytherapy recommended will depend upon the type of cancer, its location, and other related factors.
- Permanent brachytherapy – Once in place, the seeds emit radiation to the specific area of the body for several weeks or months. Because the seeds are very small and cause little discomfort, the radioactive materials break down over time, leaving nothing else in the body once they’re gone.
- Temporary brachytherapy – This cancer treatment can be delivered with a high-dose rate (HDR) or low-dose rate (LDR) of radioactive material that is placed into the body through cylinders, hollow needles, catheters (tubes), or fluid-filled balloons into the area to be treated and then removed after treatment, typically by a cancer specialist. Or, the radioactive material can be put into the device remotely by machine.
- HDR (High-dose rate of radiation): the HDR Brachytherapy radiation source is put into place, often for only a few minutes at a time, and then removed. This process may be repeated for just a few minutes over the course of a few weeks. Your oncologist will decide what is right for you. HDR is available to treat:
- Breast cancer
- Gynecological cancers, including cervical, vaginal, and uterine cancer
- Prostate cancer
- Skin cancer
- LDR (Low-dose rate of radiation): the radiation source stays implanted in place for up to seven days and requires a hospital stay in bed and lying very still.
Types of cancer often treated with HDR brachytherapy
If diagnosed with early-stage breast cancer, your oncologist may recommend treatment to include a lumpectomy followed by HDR brachytherapy. In this form of partial breast irradiation (APBI), the SAVI™ applicator device may be used with its multiple catheters to specifically target tissue over the course of 5 days or less. This is sometimes referred to as “Five-Day Breast Cancer Treatment.”
Brachytherapy can be used as part of the treatment plan for some gynecological cancers, including:
- Cervical cancer – Often treated with both chemotherapy and radiation therapy.
- Vaginal and endometrial cancers – Primarily treated with surgery, although additional chemotherapy and/or radiation may also be recommended.
- Uterine or endometrial cancer – If cancer is present in the cervix, ovaries, or uterus, a hysterectomy (removal of the uterus) may be part of the treatment, combined with chemotherapy and/or radiation therapy.
HDR brachytherapy can be used and is typically an outpatient process where the radiation source is put into place, often just for a few minutes at a time, and then removed. This process may be repeated for just a few minutes over the course of a few weeks.
Brachytherapy alone is generally used only in men with early-stage prostate cancer that is relatively slow growing (low-grade). The seeds are typically placed using a surgical procedure and then left in the body to break down on their own. Brachytherapy combined with external radiation is sometimes an option for men who have a higher risk of the cancer growing outside the prostate.
In some patients, HDR (high-dose radiation) brachytherapy can be an effective skin cancer treatment and is often used when the cancer is not completely removed through surgery when the cancer is in a delicate area of the body where surgery would cause too much scarring, or where surgery would be too difficult to perform.
HDR brachytherapy delivers treatment quickly, powerfully, and precisely using tiny radioactive seeds that travel through a plastic applicator, typically set on top of the skin and placed precisely where the cancer is located to deliver the radiation directly. Procedures are customized for each patient and are typically non-invasive, non-scarring, and outpatient.
Is Brachytherapy for Me?
Any cancer treatment option should be discussed with your oncologist, be based upon your individual circumstance, and be selected with the highest rate of success expected given your personal situation.
HDR Brachytherapy is performed by Virginia Oncology Associates in many areas of Virginia. You can make an appointment to talk with one of our radiation oncologists to get all of your questions answered.