Brachytherapy, may also be referred to as internal radiotherapy, which is your first clue to what it is. Brachytherapy is radiotherapy where radioactive material is placed inside your body, next to or around a tumour. The material ‘decays’ over time losing its power, so should not need removal. It may be employed on its own, following surgery, or in conjunction with chemotherapy and other drugs. It is often referred to as High Dose-Rate (HDR) Brachytherapy, especially in the USA.
One big advantage of the treatment is the time saved. The patient does not need to travel five times a week for six weeks to a hospital as they do with standard external radiotherapy. This is also good news for the hospital and its limited resources. Furthermore, many patients using standard radiotherapy miss a few of the treatment sessions, thus putting themselves at risk by having a lower dose than prescribed. This does not happen with brachytherapy; the dose is calculated and fully delivered.
Delivery
There are several methods used to implant the material, which depending upon the tumour may be in one piece or several. With prostate cancer radioactive ‘seeds’ are used in the prostate area. You should be absolutely clear before the procedure what it entails.
Which cancers may be treated with brachytherapy?
To date it has been used with a number of solid tumours, in the UK typically prostate. Although medical opinion seems very supportive of brachytherapy with prostate cancer, often calling it an ‘advanced treatment’, it has to be said that this treatment is controversial, especially with breast cancer.
In the USA brachytherapy has been used for the following cancers:
- Prostate cancer
- Breast cancer
- Lung cancer
- Ovarian and endometrial cancers
- Oesophageal cancer
It is claimed that this treatment allows higher doses of radiotherapy to be delivered to a specific tumour resulting in shorter treatment times, and that it will cause fewer side-effects than the typical external beam radiotherapy.
It is claimed that ‘side-effects are confined to the localised region of the tumour and tenderness and swelling are possible’.
Why is it controversial?
Brachytherapy was first approved by the FDA in America in 2002 and, despite the hype, is an alternative cancer therapy to traditional radiotherapy. Ten years on, whilst many oncologists make claims about its performance, there simply is little research to support the claims, especially over the longer-term. Yet its usage in breast cancer treatment in the USA is steadily growing. Overall, some 15 per cent of women in America choose this as their preferred form of radiotherapy for breast cancer. In some localised regions this figure can be as high as 70 per cent.
However - PLEASE NOTE - Some American oncologists are urging caution; others actually claim that it does not work as well as traditional radiotherapy, and have limited research to back up this view. There are no long-term phase III clinical trials (a ‘reason’ often used by ‘skeptics’ against many alternative cancer treatments).
Equally, critics claim there are no meaningful studies on safety and side-effects over the long-term. Ten years on, this is what Yale School of Medicine had to say in October 2012, following their research:
"The breast cancer treatment brachytherapy — heralded for its low complication rates — actually results in more complications than whole-breast radiation one year after treatment" (October 2012; Journal of Clinical Oncology).
The standard treatment for older women with early stage breast cancer includes breast-conserving surgery, typically followed by radiation therapy to reduce the risk of breast cancer recurrence. Rather than irradiating larger areas of the breast, as in whole breast irradiation, brachytherapy temporarily implants radiation sources in catheters within the surgical site. This technique delivers larger and fewer radiation doses directly to the breast tissue, which results in a shortened treatment time and, proponents of the therapy believe, decreased toxicity to surrounding healthy tissue.
“This treatment method seems ideal in theory, but we found it concerning that such an important clinical decision that affects so many women was being made on the basis of theory, rather than scientific evidence,” said the study’s lead author Dr. Cary P. Gross, associate professor of internal medicine at Yale School of Medicine.
The team found that the use of brachytherapy was associated with a 16.9% higher rate of wound and skin complications in the year after treatment compared to whole breast irradiation. There was no significant difference in the rate of deep tissue or bone complications between the two treatments. The research was funded by the NCI.
Precautions
Hospitals may recommend the following precautions for prostate patient usage:
* Prostate cancer should not allow children to sit on their lap, nor cuddle pregnant women.
* Sexual intercourse should be avoided for up to a month and a condom should be used to avoid the slight possibility of a seed passing to the female in the sperm.
You may also ring alarm bells in airports!