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Brachytherapy allows a physician to use a higher total dose of radiation to treat a smaller area and in a shorter time.

High-Dose Radiation (HDR) Brachytherapy

Brachytherapy remains an integral component in the treatment of cancer in both an outpatient and an inpatient setting. It involves the placement of either permanent seeds or hollow needles into the tumor though which a radioactive source can irradiate tumor from the inside out. By placing these needles into the tumor, we can avoid irradiating surrounding critical organs. The operator must be well trained to perform these highly technical procedures, and we at the CCI remain at the forefront of these procedures. We have been trained to perform procedures such as intracavitary and interstitial brachytherapy for prostate, cervical, endometrial, breast and sarcomatous tumors. In addition, with the use of high dose rate brachytherapy, we have dramatically reduced the treatment times to minutes. With the help of our physics team, we are the leading experts in the South Bay in performing these highly specialized techniques. Examples of brachytherapy procedures performed include: 

  • Breast Cancer: Multi-catheter balloon placement for Accelerated Partial Breast Irradiation. Accelerated partial breast irradiation (APBI) focuses higher doses of radiation during a shorter interval to the lumpectomy cavity, in the setting of breast conserving therapy for early stage breast cancer. The utilization of APBI has increased in the past decade because of the shorter treatment schedule and a growing body of outcome data showing positive cosmetic outcomes and high local control rates in selected patients undergoing breast conserving therapy. Technological advances in various APBI modalities, including intracavitary and interstitial brachytherapy, intraoperative radiation therapy, and external beam radiation therapy, have made APBI more accessible in the community.

  • Prostate Cancer: Permanent seed placement using Iodine-125 brachytherapy seeds or high dose rate brachytherapy using the Syed-Neblett Template 

  • Cervical Cancer: High dose rate brachytherapy using the tandem and ovoid system. For locally advanced disease, we use interstitial brachytherapy using the Syed Neblett template. We are currently one of the hand full of centers capable of performing this procedure using this template in the entire nation. 

  • Endometrial Cancer: Vaginal cylinder brachytherapy

Side Effects

In permanent brachytherapy, also called seed implantation, needles that are pre-filled with the radioactive seeds are inserted into the tumor. The needle or device is then removed, leaving the radioactive seeds behind. Seeds may also be implanted using a device that inserts them individually at regular intervals. X-rays, ultrasound, MRI or CT scans may be used to assist the physician in positioning the seeds. Additional imaging tests may be done after the implantation to verify seed placement.

Early side effects may include:

  • Local swelling

  • Local bruising

  • Discharge in cases of vaginal or womb cancer.

  • Semen may be discolored and, in rare cases, may contain expelled pellets. Patients are therefore advised to use barrier contraception during sexual intercourse.

  • Bleeding

  • Pain and discomfort at the site of the implant

  • General feeling of fatigue

  • Brachytherapy used for uterine, cervical, vaginal or prostate cancer can lead to short-term urinary symptoms including urinary retention, pain on urination, incontinence and inability to urinate. Brachytherapy for these cancers can also lead to diarrhea, constipation and some rectal bleeding.

Long term side effects, which are rare, include:

  • Infertility

  • Erectile dysfunction

Those with permanent implants may be advised to avoid making close contact with people for the first few days after the implant when the radiation is most active. These individuals may also be told to restrict any daily contact with pregnant women or children to no more than a few minutes for the first few weeks or months. People with permanent implants should also be aware that the radiation in the brachytherapy seeds can set off airport radiation sensors.

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