Table of ContentsView AllTable of ContentsPurposeTypesDosageThe ProcedureSide EffectsCostContraindicationsBrachytherapy for Other Types of Cancer
Table of ContentsView All
View All
Table of Contents
Purpose
Types
Dosage
The Procedure
Side Effects
Cost
Contraindications
Brachytherapy for Other Types of Cancer
Brachytherapyis a type of cancer treatment, also called internal radiation therapy, that involves placing a sealed radioactive source in or near a tumor to destroy the cancer cells. It is used to treat many different types of cancer but can be used in breast cancer to kill cancer cells after alumpectomy. It’s also used to reduce the size of a tumor beforebreast cancer surgeryor aspalliative treatmentto reduce pain or bleeding in advanced or inoperable disease.
Brachytherapy is used to treat early-stage breast cancers that have not spread (metastasized) to other parts of the body. The treatment can be delivered in different ways and is often combined with conventionalexternal beam radiation therapy (EBRT).
Despite strict selection criteria, an estimated 71,000 American women would benefit from breast brachytherapy each year, according to a2017 review of studiesin theJournal of Contemporary Brachytherapy.
Verywell / Emily Roberts
Purpose of Treatment
One of the main advantages of breast brachytherapy compared to whole-breast irradiation is that a higher dose of radiation can be precisely delivered with less damage to surrounding tissues of the breast, ribs, and lungs.
Brachytherapy Types
There are five methods used to deliver breast brachytherapy, each of which has specific purposes and indications:
According to a2017 review of studies, breast brachytherapy can reduce the rate of cancer recurrence from 13.3% to 6.3% when used with EBRT.
Higher dose rates are associated with shorter treatment times, and vice versa. With HDR brachytherapy, the implants are placed for only a few minutes at a time and then removed, with additional treatments given every several days or weeks. With LDR brachytherapy, the radioactive source may be left in for one or several days.
Of all the dose rate options, HDR brachytherapy is the one most commonly used for breast cancer. When used on its own, HDR brachytherapy can reduce the treatment time from six to seven weeks for EBRT to just five days.
LDR and MDR brachytherapy are typically used to “boost” EBRT following surgery, while ULDR brachytherapy is reserved for permanent implants, including PBSI.
PDR brachytherapy is a more recent innovation that combines the efficacy of HDR technology with the improved tissue safety of LDR brachytherapy.
Brachytherapy requires a treatment team, which may include a radiation oncologist,dosimetrist,radiation therapist, nurse, and occasionally a surgeon.
With the exception of NIBB, breast brachytherapy will involve some sort of invasive procedure. The radioactive source may be delivered using a needle-like applicator, via one or more temporary catheters, or during breast surgery.
The implantation is usually performed in a hospital operating room specially designed to keep radiation from seeping out. Depending on the procedure, you will either be givenlocal anesthesiato numb the general area orgeneral anesthesiato put you to sleep.
As with any procedure involving anesthesia, you will be given specific instructions on when to stop eating or drinking before the procedure.
During the Procedure
Breast brachytherapy requires an imaging tool, such as anX-ray,ultrasound, orcomputed tomography (CT), to direct the placement of the radioactive source. Once the coordinates are determined, one or more sources are strategically placed to target cancer but spare the surrounding cells.
The various procedures can be broadly described as follows:
After the Procedure
After the brachytherapy procedure is finished, you are led to the recovery room and monitored from anywhere from 30 minutes to several hours. You will likely feel localized pain around the implantation site. You may also have swelling, redness, and bruising.Side effectsfrom the anesthesia may include sleepiness, confusion, and nausea.
Some radioactive implants may be left in place from one to several days. If so, you will probably need to remain in the hospital during treatment, often in a special radiation-proof room. Larger implants may require you to stay in bed without moving.
If you have been given permanent brachytherapy seeds, you can usually go home the same day. The radiation will wear off in a couple of weeks, and the seeds will slowly deteriorate over time.
Tips for Multiple Procedures
If multiple treatments are required, you will need to care for the breast catheters until the treatment is completed. You will still be able to perform most daily routines and drive yourself to and from the healthcare provider’s office.
There are several precautions to take to help reduce the risk of injury or infection. These can include:
Call your healthcare provider immediately if you experience high fever (over 100.5 degrees F) or develop severe pain, redness, swelling, or pus-like discharge around a catheter or incision site.
Once you have finished treatment, the catheters will be removed. Additional evaluations to assess your response should be scheduled.
Beyond the effects of the surgery itself, brachytherapy can cause both acute and long-term side effects. These tend to be far less severe than with EBRT.
Fatigue is the most common short-term side effect lasting for one or several days. Less commonly, there may be a generalized soreness in the treated breast.A mild pain reliever like Advil (ibuprofen), Aleve (naproxen), or Tylenol (acetaminophen) can usually ease breast tenderness.
In some cases, the implantation of the catheter can cause aseroma, a pocket of fluid beneath the skin that may require drainage with a needle as well asoral antibiotics.
Long-term side effects are less common but may include a change in skin texture and color, skin dryness, and a loss of hair under the arm. Moisturizing the skin can usually help.
You may also experience the swelling of an arm if brachytherapy was performed near the axillary lymph nodes in the armpit. Known aslymphedema, the condition will usually be mild and resolve on its own without treatment. Call your healthcare provider if the condition persists or worsen.
The cost of treating breast cancer with brachytherapy can vary greatly. One study found that whole-breast brachytherapy was less expensive overall (and more effective) than the older approach of brachytherapy-based accelerated partial breast radiotherapy.
The findings suggested that one year of the whole-breast approach cost between $6,375 and $19,917, which could save between $4,886 and $4,803 compared to the partial-breast treatment.
It’s worth noting that most major insurance companies cover at least part of the cost for brachytherapy.
Breast brachytherapy is not for everyone. Although most people with breast cancer will benefit from lumpectomy and EBRT, only a subgroup are appropriate candidates for breast brachytherapy. Some of the contraindications include:
In addition to treating breast cancer, brachytherapy is used on different types, including head and neck, eye, and prostate. Brachytherapy is also an effective treatment option for those with cervical cancer, which uses intracavity brachytherapy and involves radiation being placed in the vagina as a treatment.
Just like with breast cancer, the success rates of brachytherapy in other types of cancer vary depending on type and severity, but it is generally considered an effective treatment. For example, in cervical cancer, the treatment can achieve control rates of 100% for stage 1, 96% for stage 2, and 86% for stage 3 cancers.
Summary
Brachytherapy can be used in early-stage breast cancers as part of a comprehensive treatment plan. While it is not a first-line treatment, it can help boost the effectiveness of EBRT.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Cancer Institute.Brachytherapy to treat cancer.Smith GL, Jiang J, Buchholz TA, et al.Benefit of adjuvant brachytherapy versus external beam radiation for early breast cancer: impact of patient stratification on breast preservation.Int J Radiat Oncol Biol Phys. 2014;88(2):274–284. doi:10.1016/j.ijrobp.2013.07.011Skowronek J.Current status of brachytherapy in cancer treatment - short overview.J Contemp Brachytherapy. 2017;9(6):581–589. doi:10.5114/jcb.2017.72607American Society of Anesthesiologists.Effects of anesthesia.Albuquerque K, Tell D, Lobo P, Millbrandt L, Mathews HL, Janusek LW.Impact of partial versus whole breast radiation therapy on fatigue, perceived stress, quality of life and natural killer cell activity in women with breast cancer.BMC Cancer. 2012;12:251. doi:10.1186/1471-2407-12-251Breastcancer.org.Seroma (fluid build-up).Heather T. Gold, Dawn Walter, Eleni Tousimis, and Mary Katherine Hayes.New Breast Cancer Radiotherapy Technology Confers Higher Complications and Costs Before Effectiveness Proven: A Medicare Data Analysis.Inquiry. 2018 Jan-Dec; 55: 0046958018759115. Published online 2018 Mar 5. doi: 10.1177/0046958018759115Skowronek J, Chicheł A.Brachytherapy in breast cancer: an effective alternative.Prz Menopauzalny. 2014;13(1):48–55. doi:10.5114/pm.2014.41090National Cancer Institute.Brachytherapy to Treat Cancer.Vonetta M. Williams, Jenna M. Kahn, Nikhil G. Thaker, Sushil Beriwal, Paul L. Nguyen, Douglas Arthur, Daniel Petereit, and Brandon A. Dyer.The Case for Brachytherapy: Why It Deserves a Renaissance.Adv Radiat Oncol.2021 Mar-Apr; 6(2): 100605. Published online 2020 Nov 6. doi: 10.1016/j.adro.2020.10.018
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Cancer Institute.Brachytherapy to treat cancer.Smith GL, Jiang J, Buchholz TA, et al.Benefit of adjuvant brachytherapy versus external beam radiation for early breast cancer: impact of patient stratification on breast preservation.Int J Radiat Oncol Biol Phys. 2014;88(2):274–284. doi:10.1016/j.ijrobp.2013.07.011Skowronek J.Current status of brachytherapy in cancer treatment - short overview.J Contemp Brachytherapy. 2017;9(6):581–589. doi:10.5114/jcb.2017.72607American Society of Anesthesiologists.Effects of anesthesia.Albuquerque K, Tell D, Lobo P, Millbrandt L, Mathews HL, Janusek LW.Impact of partial versus whole breast radiation therapy on fatigue, perceived stress, quality of life and natural killer cell activity in women with breast cancer.BMC Cancer. 2012;12:251. doi:10.1186/1471-2407-12-251Breastcancer.org.Seroma (fluid build-up).Heather T. Gold, Dawn Walter, Eleni Tousimis, and Mary Katherine Hayes.New Breast Cancer Radiotherapy Technology Confers Higher Complications and Costs Before Effectiveness Proven: A Medicare Data Analysis.Inquiry. 2018 Jan-Dec; 55: 0046958018759115. Published online 2018 Mar 5. doi: 10.1177/0046958018759115Skowronek J, Chicheł A.Brachytherapy in breast cancer: an effective alternative.Prz Menopauzalny. 2014;13(1):48–55. doi:10.5114/pm.2014.41090National Cancer Institute.Brachytherapy to Treat Cancer.Vonetta M. Williams, Jenna M. Kahn, Nikhil G. Thaker, Sushil Beriwal, Paul L. Nguyen, Douglas Arthur, Daniel Petereit, and Brandon A. Dyer.The Case for Brachytherapy: Why It Deserves a Renaissance.Adv Radiat Oncol.2021 Mar-Apr; 6(2): 100605. Published online 2020 Nov 6. doi: 10.1016/j.adro.2020.10.018
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Cancer Institute.Brachytherapy to treat cancer.Smith GL, Jiang J, Buchholz TA, et al.Benefit of adjuvant brachytherapy versus external beam radiation for early breast cancer: impact of patient stratification on breast preservation.Int J Radiat Oncol Biol Phys. 2014;88(2):274–284. doi:10.1016/j.ijrobp.2013.07.011Skowronek J.Current status of brachytherapy in cancer treatment - short overview.J Contemp Brachytherapy. 2017;9(6):581–589. doi:10.5114/jcb.2017.72607American Society of Anesthesiologists.Effects of anesthesia.Albuquerque K, Tell D, Lobo P, Millbrandt L, Mathews HL, Janusek LW.Impact of partial versus whole breast radiation therapy on fatigue, perceived stress, quality of life and natural killer cell activity in women with breast cancer.BMC Cancer. 2012;12:251. doi:10.1186/1471-2407-12-251Breastcancer.org.Seroma (fluid build-up).Heather T. Gold, Dawn Walter, Eleni Tousimis, and Mary Katherine Hayes.New Breast Cancer Radiotherapy Technology Confers Higher Complications and Costs Before Effectiveness Proven: A Medicare Data Analysis.Inquiry. 2018 Jan-Dec; 55: 0046958018759115. Published online 2018 Mar 5. doi: 10.1177/0046958018759115Skowronek J, Chicheł A.Brachytherapy in breast cancer: an effective alternative.Prz Menopauzalny. 2014;13(1):48–55. doi:10.5114/pm.2014.41090National Cancer Institute.Brachytherapy to Treat Cancer.Vonetta M. Williams, Jenna M. Kahn, Nikhil G. Thaker, Sushil Beriwal, Paul L. Nguyen, Douglas Arthur, Daniel Petereit, and Brandon A. Dyer.The Case for Brachytherapy: Why It Deserves a Renaissance.Adv Radiat Oncol.2021 Mar-Apr; 6(2): 100605. Published online 2020 Nov 6. doi: 10.1016/j.adro.2020.10.018
National Cancer Institute.Brachytherapy to treat cancer.
Smith GL, Jiang J, Buchholz TA, et al.Benefit of adjuvant brachytherapy versus external beam radiation for early breast cancer: impact of patient stratification on breast preservation.Int J Radiat Oncol Biol Phys. 2014;88(2):274–284. doi:10.1016/j.ijrobp.2013.07.011
Skowronek J.Current status of brachytherapy in cancer treatment - short overview.J Contemp Brachytherapy. 2017;9(6):581–589. doi:10.5114/jcb.2017.72607
American Society of Anesthesiologists.Effects of anesthesia.
Albuquerque K, Tell D, Lobo P, Millbrandt L, Mathews HL, Janusek LW.Impact of partial versus whole breast radiation therapy on fatigue, perceived stress, quality of life and natural killer cell activity in women with breast cancer.BMC Cancer. 2012;12:251. doi:10.1186/1471-2407-12-251
Breastcancer.org.Seroma (fluid build-up).
Heather T. Gold, Dawn Walter, Eleni Tousimis, and Mary Katherine Hayes.New Breast Cancer Radiotherapy Technology Confers Higher Complications and Costs Before Effectiveness Proven: A Medicare Data Analysis.Inquiry. 2018 Jan-Dec; 55: 0046958018759115. Published online 2018 Mar 5. doi: 10.1177/0046958018759115
Skowronek J, Chicheł A.Brachytherapy in breast cancer: an effective alternative.Prz Menopauzalny. 2014;13(1):48–55. doi:10.5114/pm.2014.41090
National Cancer Institute.Brachytherapy to Treat Cancer.
Vonetta M. Williams, Jenna M. Kahn, Nikhil G. Thaker, Sushil Beriwal, Paul L. Nguyen, Douglas Arthur, Daniel Petereit, and Brandon A. Dyer.The Case for Brachytherapy: Why It Deserves a Renaissance.Adv Radiat Oncol.2021 Mar-Apr; 6(2): 100605. Published online 2020 Nov 6. doi: 10.1016/j.adro.2020.10.018
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