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Brachytherapy in types of Cancer

Brachytherapy, also called internal radiation is a procedure that involves placing radioactive material inside the body to treat cancer and is extremely useful in the eradication of local tumors of prostate, cervix, head and neck, breast cancer, gallbladder, uterus, vagina, lung and rectum. When compared to the external beam radiation treatment, brachytherapy is used to treat a smaller area and allows doctors to deliver higher doses of radiation to more-specific areas of the body. The overall treatment time is very short and may cause fewer side effects than does external beam radiation. The radiation dose delivered by brachytherapy is critical in curing patients of cancer and has been the standard of treatment in Europe and America.

Brachytherapy requires very high specialized skilled doctors to do the procedure and not all centers in India have the expertise to perform brachytherapy.  It is important to be evaluated and treated at a center that has experience and expertise in offering the full range of possible treatments so that the most appropriate one is selected and performed safely. At MIO our doctors have been trained at international centers and have nearly 25 years of experience in doing this difficult procedure. We regularly do brachytherapy for cervical and oral cancers and many of our patients are surviving and doing well.

How is Brachytherapy procedure conducted and how does it work?

In brachytherapy, tiny, hollow catheters are temporarily inserted directly into a tumor. Before each treatment, we check the position of the catheters with millimeter precision. Next, a series of radioactive pellets are inserted into each catheter. Computer guidance controls (1) how far the pellet goes into the catheter to precisely target the location of tumors, and (2) how long the pellet stays in the catheter to release its radiation dose. With a few well-placed catheters, HDR brachytherapy can provide a precise treatment that takes only a few minutes.

Brachytherapy offers a quicker, more effective type of radiation treatment for some patients. For many cancer types, the entire brachytherapy treatment takes one to two days, instead of five to seven weeks for external beam radiation therapy. Depending on the type and stage of cancer, brachytherapy may be combined with other treatments, which can vary treatment times.

The optimal delivery of a brachytherapy implant necessitates a collaborative multidisciplinary team approach. This should involve a radiation oncologist trained in brachytherapy techniques, a head and neck surgeon and an oncologic nurse familiar with issues specific to brachytherapy implants, a physicist trained in brachytherapy treatment planning, and a dental surgeon experienced in radiation complications and the fabrication of spacers and lead-embedded prostheses. Such a team permits a smooth and efficient integration of treatment modalities, which may influence local control rates.

Patients are given moderate sedation for the tandem and ovoid applicator placement.  After the applicator is placed a CT scan or MRI is done to visualize the applicator relative to the patient’s anatomy and residual tumor. Then a customized plan is generated.  Once this is ready the tandem and ovoid applicator is connected via transfer tubes to the HDR afterloader.  The HDR afterloader has a motorized cable with a small radiation source welded to the end of it.  This radiation source is pushed to the top of the cylinder and delivers a radiation treatment over about 5-10 minutes.  The source is then retracted back into the afterloader.  The applicator is then removed and the patient goes home.  The whole process typically takes 2-3 hours.

Brachytherapy for cervical cancer:

Cervical cancer is the leading cause of cancer in women in India and brachytherapy treatment is a standard component of treatment for cervical cancer. From an therapeutic aspect global studies have demonstrate that women actually live longer when they receive brachytherapy than if brachytherapy is replaced with just external beam radiation therapy. At MIO brachytherapy is most commonly given after completing external beam radiation therapy.  It is most standardly given two times per week as an outpatient for a total of 5 treatments. The most heartening aspect for us that we have patients surviving even after 4 years of receiving the treatment

Brachytherapy in head and neck cancers

At MIO we regularly use brachytherapy in the management of head and neck cancers and our results have been extremely good at locoregional control of cancer, minimize treatment-related functional deficits and to preserve quality of life. In addition, the ongoing risk of second malignancies and locoregional recurrences in the head and neck requiring reirradiation make brachytherapy implants particularly appealing. The use of a brachytherapy implant affords a unique approach to local dose intensification, improving the likelihood of functional organ preservation and minimizing treatment morbidity as a result of reduced irradiation to the surrounding normal tissues.

In early-stage lesions, where the risk of nodal metastases is low, brachytherapy may be employed definitively or in an adjuvant fashion following surgery. In more advanced lesions, it is often combined with external-beam radiation therapy of the head and neck. The ability to provide specific, intensive local irradiation also permits the selective use of brachytherapy in the setting of recurrent or second head and neck SCC occurring within a previously irradiated region.

MIO’s experience with Brachytherapy:

We are one of the few hospitals in India to have made it our priority to use brachytherapy and Dr Suresh Rao and Dr Sanath Hegde, our senior consultants have been using this technique for nearly 25 years with very good results for both cervical and oral cancers. Our experience of over 5 years especially with head and neck cancers have shown that brachytherapy subsequent to conventional radiation causes complete remission and some patients with advanced cancers have had a better survival and quality of life. Further, brachytherapy subsequent to conventional radiation and followed by surgery have also shown good survival in patients with advanced cancers of the tongue.

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