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What does treatment involve?

Understanding the brachytherapy procedure

The exact procedure used to deliver brachytherapy depends on the the type of cancer being treated.

The broad process of a brachytherapy procedure is outlined in further detail below.

Initial planning 1,2

  • A clinical examination is performed to understand the characteristics of the cancer.
  • This will include investigating the size and position of the tumor and its relation to surrounding tissues and organs.
  • A range of imaging equipment, such as x-ray, ultrasound, computed tomography (CT scan) and magnetic resonance imaging (MRI) are used, which allow the healthcare team to get a precise picture of the tumor.
  • The clinical examination and images of the tumor help the healthcare team to plan how best to deliver the radiation.
  • The planning will include consideration of:

    • how to most effectively deliver the radiation to the tumor
    • what dose of radiation is needed
    • exactly where the radiation sources should be placed in or next to the tumor

 

Inserting the applicator1

After the initial planning, the images from the scans are used to insert and correctly position the hollow applicators that will be used to deliver the radiotherapy.

Once the applicators are in place, they are held in position using adhesive tape or stitches to prevent them from moving.

Refining the treatment plan1

3D images in brachytherapy

     

Computer software is used to create a 3D ‘virtual’ patient.

The healthcare team uses this to determine if the applicators are in the correct place to deliver the best possible dose of radiation.

The virtual patient shows a graphical representation of the distribution of the radiation and serves as a guide for the healthcare team to refine the position of the applicators and the treatment plan before actual treatment begins.

     

Treatment delivery1

Once the treatment plan has been finalized, the radiation is delivered to the tumor by a technique known as ‘afterloading’.
Following correct placement of the applicators, they are connected to an ‘afterloader’ machine. This machine contains the radioactive sources.
The treatment plan is sent to the afterloader, which then controls the delivery of radiation sources.
The radiation sources are delivered to the tumor via the applicators.
This system limits the risk of radiation exposure to the patient and healthcare team as the treatment team can monitor the treatment from a separate room.

     

The radiation sources remain in place for a specified amount of time.
For most types of brachytherapy treatment, the radiation sources are returned to the afterloader via the applicators (temporary brachytherapy).
The procedure is slightly different for some types of prostate cancer treatment, where the radiation sources can be placed permanently in the body (permanent brachytherapy or 'seed' therapy).
The applicators are then carefully removed from the body.
Patients typically recover very quickly from the procedure.
Brachytherapy is often performed on an outpatient basis, meaning an overnight stay in hospital is usually not needed.

     

After treatment2

After treatment has finished, the healthcare team will monitor a patient's progress via regular check-ups. The schedule for these check-ups will be determined in a patient’s treatment plan.

References
1. Patel RR and Arthur DW. Hematology/Oncology Clinics of North America 2006;20(1):97–118.
2. National Cancer Institute. Available at: www.cancer.gov/cancertopics/factsheet/Therapy/radiation. Accessed 2 February 2011.