What Is Brachytherapy?

There are many approaches to cancer treatment. And it can be difficult to know which one may best suit your particular needs. Brachytherapy is a type of radiation therapy for cancer. It involves placing radioactive material into or up against a tumor. Brachytherapy can treat several types of cancer. 

Although the use of brachytherapy for certain cancers has gone down over the years, it continues to be an important tool in cancer treatment. In this article, we’ll review different brachytherapy types and techniques. We’ll also discuss common uses of brachytherapy, so you can make an informed decision about your next steps.  

What are the types of brachytherapy?

There are three main methods to apply brachytherapy. The part of the body and the type of cancer that need treatment help to determine the particular technique. But the goal of all the techniques is the same — deliver a high dose of radiation to cancer cells while avoiding healthy tissues:

1. Intracavitary brachytherapy: This involves putting an applicator into an opening in the body. A common example is placement of a vaginal cylinder after surgery for uterine cancer.

2. Interstitial brachytherapy: This involves placing hollow needles into an organ or tissue.  A common example is the placement of radioactive “seeds” to treat prostate cancer.

3. Surface brachytherapy: This involves placing an applicator on the skin to treat skin cancer.

Another variable is the dose rate, which also depends on the type of cancer and body part. This refers to how quickly the radiation dose is delivered:

• Low-dose rate (LDR): LDR brachytherapy delivers the dose over days, weeks, or months. Often, the radioactive material is implanted permanently and decays over time.

• High-dose rate (HDR): HDR brachytherapy delivers the radiation dose more quickly. It usually takes minutes. The radioactive material is placed in the body and then removed. 

What types of cancer does brachytherapy treat?

Radiation oncologists, doctors trained in radiation therapy, use brachytherapy to treat many different cancers. Some of the most common uses include:

• Prostate cancer: Interstitial brachytherapy is a common technique for prostate cancer, with either LDR or HDR. Experts sometimes combine brachytherapy with external beam radiation therapy (EBRT).

• Uterine cancer: Brachytherapy can help prevent uterine cancer from coming back after surgery. This is usually HDR treatment with a vaginal cylinder.

• Cervical cancer: Intracavitary HDR brachytherapy commonly follows chemotherapy and EBRT.

• Breast cancer: Brachytherapy — often with an intracavitary balloon — can help prevent breast cancer from coming back after lumpectomy. 

• Skin cancer: In some cases, brachytherapy can be an alternative to surgery. This is usually HDR treatment with a surface applicator.

• Other cancers: Brachytherapy can also treat rectal cancer, ocular melanoma, and more.

How is it performed?

Radiation oncologists perform brachytherapy. They can do some types of brachytherapy in the clinic without anesthesia. Examples include treatment of skin cancer and uterine cancer.

In other cases, they perform brachytherapy in an operating room under anesthesia. For example, interstitial brachytherapy for prostate cancer requires sedation.  Similarly, brachytherapy for cervical cancer can also involve sedation.

The first step in treatment is for the provider to place an applicator in the body that needs treatment. Next, the provider loads the applicator with radioactive material. In some cases, the provider removes the radioactive material after treatment. In other cases, the radioactive material stays in the body.

What is the difference between brachytherapy and external beam radiation therapy?

Brachytherapy and external beam radiation therapy (EBRT) are two different forms of radiation treatment. Radiation oncologists deliver both forms. And both are safe and effective treatments.

EBRT most commonly works as an X-ray therapy. A person getting EBRT lies down on a treatment table, and an X-ray machine points a beam at the target.

Brachytherapy usually involves the placement of radioactive material into the body. This is why it’s often referred to as “internal” radiation therapy.

The decision to use brachytherapy or EBRT depends on many factors. For example, the cancer type, stage, and location all play a role in the decision. So each person’s case is different. In some cases, experts combine EBRT and brachytherapy for the best possible results.

How effective is brachytherapy?

Brachytherapy provides excellent results in several cancer types.

In cervical cancer, brachytherapy leads to better survival compared to other radiation techniques.

In prostate cancer, brachytherapy has excellent outcomes in low-risk and intermediate-risk disease. In high-risk prostate cancer, combining EBRT with brachytherapy has better outcomes than EBRT alone.

Treatment for early stage breast cancer includes surgery and then radiation. In these cases, there are similar results with brachytherapy or EBRT.

What are the side effects?

Brachytherapy works by placing a device in the body, so the device can cause issues at the placement site and surrounding area. For example, side effects from interstitial brachytherapy can include pain or bleeding from the implant.  

The radiation can also cause side effects. The side effects from radiation depend on what tissues are nearby. For example, radiation to the pelvis can cause irritation of the rectum or bladder. This can cause symptoms like frequent and urgent urination or diarrhea.

Most side effects get better after a few months. Your treatment team will provide instructions for how to care for them and when to get help. But in some cases, radiation side effects can be long lasting. It’s difficult to predict when this might happen, but dose and location may play a role. Your provider can help you understand your risks before treatment.

How important is brachytherapy?

In many cancers, increasing the dose of radiation improves the likelihood of having a successful treatment. And brachytherapy can safely deliver higher radiation doses than EBRT.  

The use of brachytherapy for some cancers — such as cervical cancer — has decreased over the years. There are some likely reasons for this trend. First, radiation oncology training puts less emphasis on brachytherapy than it did in the past. Also, insurance reimbursement for brachytherapy services has gone down. 

Survival rates for cervical cancer have decreased, as well as the use of cervical cancer brachytherapy. This has led some experts to warn that leaving out brachytherapy is inappropriate and can lead to worse outcomes. They believe the higher radiation dose that brachytherapy delivers is an important part of treatment.

There’s a similar trend in prostate cancer, with declining use of brachytherapy over time. This trend is worrisome, particularly given the benefits of prostate brachytherapy in certain cases. 

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Written by:

David Marcus, MD

David Marcus, MD, is a board-certified radiation oncologist with expertise in the management of many types of cancer, including prostate cancer, breast cancer, and several others. He earned his medical degree at Emory University in Atlanta, Georgia, where he also completed residency training in radiation oncology.

Edited by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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