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Radiotherapy is a cancer treatment that involves the targeted use of high-energy light or particles to kill cancer. Radiation is usually delivered externally, or from outside of the body, and focused at the tumor. This may cause damage to organs that are in the path of the radiation beam. Internal radiation, or brachytherapy, is a different approach that involves placing radioactive sources into or near the tumor itself. Very high doses of radiation are delivered from the inside out, killing cancer cells and decreasing the risk of damage to nearby organs. The placement of radioactive sources (or seeds) internally is often called an implant.
There are many brachytherapy techniques. The recommended procedure is based on the size and location of the tumor as well as the expertise of the treating radiation oncologist. These procedures can be done in clinic or on an outpatient basis with the patient under general anesthesia.
Source placement can be permanent or temporary. With permanent placement, radioactive seeds are placed during a single procedure and left inside of the body. Permanent seeds lose their energy over time and essentially become inactive after a few weeks. With temporary placement, hollow catheters are placed into the tumor, allowing radioactive sources to temporarily enter the body, and then are removed after the procedure. Temporary implants may be spread out over multiple treatments to decrease the risk of adverse effects.
Yes. Internal radiation has been safely used since 1901 to kill cancer cells. Multiple members of the radiation treatment team help ensure the safety of internally delivered radiation, including radiation oncologists, medical physicists, nurses, and support staff. This treatment is highly regulated locally and nationally to ensure that it will not be harmful to patients or other individuals. Specific measures include the following:
Quality checks on the radioactive seeds
Preprocedure planning of source placement
Visualization of the tumor during the procedure using ultrasonography, radiography, computed tomography, or magnetic resonance imaging scans
Postprocedure imaging to confirm placement
After receiving internal radiation treatment, patients can maintain their normal life activities with minimal adverse effects and do not carry a risk of exposing others to radiation. Adverse effects are related to the location of treatment. For example, patients with cervical cancer may have burning during urination or diarrhea; patients with skin cancer may experience a sunburn-type reaction. Adverse effects generally subside within a month of treatment. If a permanent implant is placed, patients may be asked to limit close contact with children and pregnant women for a given time (weeks to 2 months) as a precautionary measure.
Brachytherapy can be used to treat prostate, cervical, uterine, skin, eye, and breast cancers. In special cases, it may also be used in other sites, such as rectal, head and neck, brain, bile duct, and lung tumors.
National Cancer Institutehttps://www.cancer.gov/about-cancer/treatment/types/radiation-therapy/brachytherapy
American Brachytherapy Societyhttps://www.americanbrachytherapy.org/resources/for-patients/
Published Online: February 13, 2020. doi:10.1001/jamaoncol.2019.5882
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Dalwadi SM, Farach AM, Ludwig MS. Brachytherapy. JAMA Oncol. Published online February 13, 2020. doi:10.1001/jamaoncol.2019.5882
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