Brachytherapy: irradiation from inside

Brachytherapy: irradiation from inside

In brachytherapy the radiation source is directly introduced into the tumour. High doses of radiation can thus be directly delivered to the cancerous tissue, sparing the skin and sourrounding structures from harm caused by excess radiation. Usually, only a few sessions are necessary.

For certain cancer patients, if surgery is not possible or external radiation would have too many side effects, brachytherapy offers an additional treatment option. The procedure, only offered by a few hospitals in Germany, is performed within our certified Oncology Centre.

Following cancers are eligible for treatment through brachytherapy: head and neck tumors, lung and oesophagus cancer, liver metastases and several gynaecological tumors.

Some particular tumors can be considered for brachytherapy as well so an individual evaluation can be performed for patients suffering from breast and prostate cancers.

Brachytherapy may be used to supplement most established tumour therapies. Besides a curative (healing) approach, palliative (quality-of-life) approaches are feasible. Local tumor control, i.e. a reduction in size in order to protect important healthy structures of the body, is another viable approach.

Treatment is teamwork

The treatment is carried out by an interdisciplinary team of radio-oncologists, medical physicists and interventional radiologists. The physicians apply a very high radiation dose directly to the tumour region in a short time. The radiotherapist needs the interventional radiologist to place the radiation source precisely into the tumor under CT or ultrasound control.

By changing the duration, dose and/or position of the applicators the team is able to treat very different types of tumours. The radioactive source, Iridium-192, radiates about ten millimetres deep into the tissue. By combining different needles, which are inserted image-guided by CT or ultrasound into the tissue from different angles and with different doses, the dimensions oft he tumour can be covered completely, sparing the surrounding healthy tissue at the same time.  

The process is fast and gentle. The needles are removed directly after irradiation. About two weeks after the procedure the tumour starts melting and the dead tissue is broken down by the body.

We will be pleased to counsel you on details on the exact procedure and the implementation of this irradiation procedure in your individual case.

Brachytherapy: questions and answers

In preparation for the brachytherapy itself the patient will be examined on an outpatient basis. After precise pre-interventional planning and interdisciplinary coordination the patient will be thoroughly informed about the general and specific risks as well as the procedure itself by both a radiologist and a radiotherapist. Here any further questions can be discussed and the treatment team will be introduced.

On the day of the procedure the patient receives painkillers via an intravenous access as well as local anaesthetics at the access site. Now the actual procedure takes place: Special hollow needles are inserted into the tumour under image guidance. The number of hollow needles depends on the size and shape of the tumour/metastasis.

Following precise calculations, the radiation source (iridium 192) is now injected into the tumour via the inserted hollow needles. The duration the radiation source remains in position determines the amount of radiation delivered. The radiation takes between ten and 45 minutes. The needles are then removed and a dressing is applied.

Usually one to a maximum of five sessions per tumour are sufficient and reasonable. If the tumour reoccurs or grows again, the procedure may be repeated.

 

A very high dose of radiation is be delivered directly to the target area - radiation damage to the skin, mucous membranes or surrounding healthy tissue as is common with external irradiation is therefore avoided. This also allows for higher radiation doses than external irradiation.

Almost any tumour size and shape can be treated through the adjustable number of hollow needles and their distribution.

Even the proximity of the tumour to large blood vessels or a strong blood circulation in the tumor are no limitations to the procedure.

If sensitive structures are located close to the tumour, the complex software-supported radiation planning would adapt the number of needles in place as well as the radiation dose in that particular area

The rate of complications requiring treatment with brachytherapy is very low. Bleeding may eventually occur but can be diagnosed quickly and hardly ever needs further treatment.
When treating large tumours, the desired tumour decay may lead to secondary bodily reactions such as chills, fever or nausea. These side-effects are very well manageable.

 

 

 

 

Usually, the patient will stay in our hospital for three days as an inpatient. The follow-up care including imaging and laboratory works is personalized and will be discussed individually.

In general, the procedure is suitable for almost all types of cancer and metastases of the trunk and extremities. The procedure is particularly well established for liver tumors and metastases – especially when other surgical options are exhausted. Even soft tissue or lymph node metastases as well as bone metastases may be treated.

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