Brachytherapy, an advanced cancer treatment providing localized, precise and high-tech radiation therapy with minimal side effects to normal tissue, is available to patients who may require this form of treatment.

Brachytherapy is an advanced cancer treatment method. Radioactive seeds or sources are placed in or near the tumour itself, giving a high radiation dose to the tumour while reducing the radiation exposure in the surrounding healthy tissues. The term "brachy" is Greek for short distance, and brachytherapy is radiation therapy given at a short distance: localized, precise, and high-tech.

Brachytherapy has now been used for over a century. Some of the diseases now treated with brachytherapy include prostate cancer, cervical cancer, endometrial cancer, and coronary artery disease. Brachytherapy has been proven to be very effective and safe, providing a good alternative to surgical removal of the prostate, breast, and cervix, while reducing the risk of certain long-term side effects.


General Side Effects

Directly following the procedure, you can expect some soreness and swelling in the treatment area, sometimes accompanied by bruising. It is usually mild and only lasts for a couple of days. Your doctor can prescribe pain medication if necessary.

You may also experience some side effects in the first couple of days after the procedure caused by the instruments used during the procedure. These include slight bleeding or burning beneath the scrotum or blood in your urine.

Good nutrition is needed for general good health and is particularly important when you are ill. During this time, it is important to give your body the proteins, fats, carbohydrates, vitamins and minerals it needs for energy, repair of normal tissue, and to keep your immune system strong to fight disease. Food is not only something to delight the taste but is an essential ingredient in the fight against disease. It is as important as your medicine or medical therapy (e.g., surgery, radiotherapy, or chemotherapy). Because of your illness or treatments, you may not be able to eat in the same way as before. You might find that your pleasurable experiences around eating are affected.


Typical High Dose Rate (HDR) Procedures

Step 1

Inserting the implant-The oncologist decides which type of implant the patient requires, based on location, tumour extent and other factors. The three types are:

Intracavitary: an applicator is inserted into a body cavity to reach the tumour. Intracavitary implants are performed in the operation theatre on an out-patient basis. Local anesthesia and/or conscious sedation is all that is required.

Intralumenal: the catheters are inserted into a "tube" structure such as the bronchus, esophagus, or bile duct. These are treated the same as intracavitary implants on an outpatient basis.

Interstitial implants are more complex. The implants are done in the operating room with the patient under local, general or spinal anesthesia. Interstitial catheters are inserted through the body tissue to encompass the tumour. In the case of prostate and gynecologic cases, a rubber template is sutured to the outside skin to hold the treatment catheters in position. In breast and head and neck cases, the treatment catheters are held in position on the skin by plastic buttons where the catheters enter and exit the skin.

Step 2

Simulation: After the implant has been placed, either CT or x-ray films are taken by the radiation therapists to determine the exact location of the implant in the body and the relationship to adjacent organs. The therapists' expertise in taking these films assures that the implant and nearby organs are visualized clearly. The physician reviews these films and makes final adjustments to the implant if necessary.

Step 3

Physicist: The CT images or films are given to the physicist to enter into the treatment planning computer. The computer does the initial calculation but it is the physicist who "fine tunes" or customizes the radiation doses to conform to the target volume while minimizing the doses to the nearby normal tissues. After the treatment plan has been approved by the oncologist, the computer transfers the treatment plan instructions to the HDR remote afterloader.

Step 4

Treatment: The patient is moved into the brachytherapy treatment room. The ends of the applicator or treatment catheters that protrude outside the body are connected to "transfer" tubes which are then connected to the afterloader. The programmed instructions tell the afterloader where to direct the source and how long the source will stay in each dwell position. The patient is alone in the treatment room while the treatment is being given, but the physicist and nurses are continually monitoring the patient through an intercom and closed circuit TV monitors. The time the source spends in the implant is about 10 to 15 minutes. The entire treatment process takes about 30-60 minutes. These time estimates will vary depending on the size and complexity of the implant and on the activity of the source. When the treatment is completed, the radiation source is retracted back into the HDR afterloader. There in no radiation left behind in the patient.

Step 5

Implant removal: After the treatment(s) have been given, the implant is removed. Intracavitary and intraluminal applicators are simple to remove and the patient goes home soon after removal. With interstitial implants, sutures holding the template and/or catheters in place are clipped and the implant is gently removed. Some minor bleeding usually occurs, which is quickly stopped by applying direct pressure to the implant site with gauze pads. Post- implant skin care instructions are given by the nurses before the patient leaves the CET clinic. A date for a follow-up appointment will also be given.

Step 6

Follow-up: It is important that the patient keep us informed as to their recovery, any side effects, etc. We pride ourselves on thorough patient follow-up, which is how we assess the efficacy of our HDR treatments.