Overview of the Brachytherapy and Treatment Process
Brachytherapy is a method of delivering radiation to tumors by placing radioactive sources in close proximity to the tumor (“intracavitary” brachytherapy) or within the tumor itself (“interstitial brachytherapy). Derived from the Ancient Greek word brachios meaning “short”, brachytherapy is sometimes referred to as “internal” radiation therapy or an “implant”. More recently, HDR have all but replaced LDR techniques in most tumor sites. Unlike LDR, HDR is an outpatient procedure avoiding the need for general anesthesia and a prolonged hospital stay at bed rest.
HDR Treatment Process
The following are the steps generally followed when a patient is preparing for brachytherapy. These may differ slightly depending on the protocol at your treatment facility or if your treatment is being done on an urgent basis, but many of the steps are the same across treatment facilities.
Whenever brachytherapy is being considered as part of your treatment plan, a consultation visit will be arranged for you with a radiation oncologist, a physician specially trained in using brachytherapy for treating your type of cancer.
The purpose of this visit is to discuss the role of brachytherapy in your treatment, to determine the type of radiation therapy to be used, the treatment plan for your treatment, and to answer any questions you may have.
The consultation will take nearly one hours, depending on your particular situation. Please bring with you all X-rays, CT Scans, MRIs, laboratory studies, pathology slides, operative reports and other tests and treatment that have been performed so that they can be reviewed by the radiation oncologist
Your physician will determine which preparations need to be done prior to your brachytherapy procedure. These may include:
- Bowel preparation
- Pre-treatment ultrasound, MRI or CT scan
- Blood tests
A few days before your procedure, you will be given specific instructions on how to prepare for your brachytherapy procedure.
Informed Consent Process
Physician will review in detail the proposed treatment, the reasons for recommending the treatment, and the potential risks and side effects of such treatment.
Ample time will be provided so that you have a full understanding of the treatment and related issues and have all of your questions and concerns answered in full.
We encourage you to bring family members or significant others with you, as they may be able to help you during the process and have their own questions answered.
Once you feel that you have a full understanding of the proposed treatment, risks, side effects and other possible treatment options, you will be asked to sign a consent form.
Before you sign the consent form, you need to make sure that you are comfortable with the explanation that you have received. Even after you have signed the consent, your physician is always available to answer new questions or to provide additional information.
Procedure and planning CT scan
Before radiation treatments begin, you will go through a treatment planning process. This process is where your radiation treatment team will precisely identify the area on your body where you will receive radiation.
Before the brachytherapy procedure begins, an intravenous line may be inserted into your arm or hand to deliver anaesthesia medications. Depending on the site of the tumour and your physician’s recommendations, you may receive general anaesthesia and/or a sedative to make you feel drowsy.
If anaesthesia or heavy sedation is used, you may be transferred to a recovery room after the procedure. Depending on the type of brachytherapy, you may return home the same day or moved to a hospital room.
In HDR brachytherapy, a delivery device, such as a catheter, needle, or applicator, is placed into the tumor using imaging such as ultrasound, MRI or CT to help position the radiation sources. The delivery device may be inserted into a body cavity such as the vagina or uterus (intracavitary brachytherapy) or applicators (usually needles or catheters) may be inserted into body tissues (interstitial brachytherapy).
A planning CT scan of the region to be treated is done. The entire process takes approximately an hour, though the actual time may vary. Since you will be lying on a table for most of this time, you may experience some discomfort. If this occur, tell the Nurse.
Keep in mind that the time necessary to deliver the actual radiation therapy treatments is only minutes, not nearly as long as the time required for the procedure and scan.
Technical Planning Process
After CT scan, the CT images details from the procedure are forwarded to planning workstation.
Radiation oncologist contour the tumour and critical structures.
Medical physicists perform dose calculations that will be used to set the HDR Ir-192 source dwell time. The physicist work closely with your radiation oncologist to develop the treatment plan, a process that can take up to few hours.
After evaluated and approved the treatment plan will send to the HDR unit. The treatment time will ensure as calculated or not. You will be placed on the treatment table in the same position as you were on the ct-scan.
Once in place on the treatment table, a source guide can be connected between HDR unit and inserted applicator/catheter. The treatment is going to be delivered.
The actual administration of the radiation treatment typically takes about 10 to 30 minutes.
Once you are set up for treatment, the radiation staff will leave the treatment room to avoid exposing them to radiation.They will be able to see and hear you from a control room just outside the treatment room. They can also give you instructions over a microphone as needed during the treatment.
If you are having a problem, you should call us with out delay. Your nurse will review your problem or concern and if he/she cannot help, will contact your physician.
Once your radiation treatments have been completed, the temporarily inserted applicator will be removed and allow you to go home.
Once your radiation treatments have been completed, you will have a visit with your physician. During this visit, your doctor will discuss follow-up care.
After the completion of radiation therapy, we will follow your progress and see you on a regular basis. We understand that you may be seeing many other physicians, but it is important for us to participate in this follow-up process so that any radiation-related problems can be identified early and treated. We will also stay in touch with your other cancer specialists.