Brachytherapy

Brachytherapy is a treatment technique in radiotherapy, involving direct irradiation of cancer cells by placing a radiation source (radioactive element) directly in the lesion (tumor) or in its immediate vicinity.

Brachytherapy is considered a procedural technique, as it requires the implantation of applicators, which in some cases can be inserted under local or general anesthesia. Depending on the time the radioactive sources remain in place, permanent implant application or temporary implant application is used. In our Affidea NU-MED brachytherapy units, temporary implants are used, i.e., empty guides, where the radioactive isotope is introduced by remote control only after the staff leaves the therapy room and is removed immediately after irradiation.

Among the Affidea NU-MED Group facilities, this method is used by centers in Zamość, Katowice, Tomaszów Mazowiecki, and Elbląg.

All our Affidea NU-MED Facilities use the high-dose-rate (HDR) technique, where the dose rate exceeds 12Gy/h. The isotope iridium (Ir-192) is used as a radiation source. The technique uses high-activity sources that emit a large dose of radiation in a short time, so the procedure can last only 10 minutes.

Depending on the radiation dose rate, the following techniques are distinguished:

LDR – (low dose rate) – below 2Gy/h HDR – (high dose rate) – above 12Gy/h PDR – (pulse dose rate) – doses are planned in pulsed form at regular intervals

Forms of Brachytherapy

Depending on how the radioactive source is placed, the following forms of brachytherapy are distinguished:

• Intracavitary brachytherapy - where the radioactive source is placed in the vicinity of the tumor
• Interstitial brachytherapy - where the radioactive source is implanted directly into the tumor volume
• Surface (contact) brachytherapy - where the radiation source is on the surface of the tumor
• 3D – HDR brachytherapy in real-time

Treatment Planning

Treatment must be planned before it begins, but in many cases, planning takes place on the same day as treatment. Planning is done through modern imaging techniques – USG, CT, MR. These methods allow for precise determination of the area to be irradiated as well as spatial reconstruction of the applicator.

Applicators are needed to introduce the radioactive source (Ir-192), and their type is selected depending on the clinical diagnosis, location, and stage of advancement. The decision on the choice of applicators is made by two radiation oncologists (treating and consulting). After the applicators are inserted, the patient undergoes diagnostic imaging (USG, CT, or MRI) to determine the irradiation area, critical organs, and applicator placement. Then, the Therapeutic Team - a medical physicist and a radiation oncologist prepare the treatment plan.

After the brachytherapy treatment plan is approved, the Patient begins therapy. During the irradiation session, the Patient is supervised by the Therapeutic Team, consisting of:

• radiation oncologist
• medical physicist
• electroradiologist

After completing brachytherapy, the Patient remains under the constant care of a radiation oncologist.

What Does Preparation and the Procedure Look Like?

In brachytherapy treatment, we distinguish two types of applications:

Large applicator system:

• Brief intravenous anesthesia of the Patient with the participation of an anesthesiologist is necessary
• Administration of appropriate medications prescribed by the doctor
• Installation of an appropriate set of applicators, adequate to the diagnosis and anatomical structures of the Patient
• Treatment planning with the installed applicator system in the CT or MRI laboratory

Small applicator system:

• The patient does not require special preparation
• The type of system is selected depending on the clinical diagnosis and stage of advancement, after consultation between the radiation oncologist and another specialist in this field
• The entire procedure lasts from 5-15 minutes

After the applicator system is installed, the medical physicist, in consultation with the doctor, prepares a treatment plan, i.e., treatment time and dose. Then, the Patient is treated with ionizing radiation arising from the decay of the radiation source placed in the microSelectron HDR therapeutic device. During treatment, the Patient is observed via a video camera system and an intercom system. The patient's safety during treatment is supervised by: a nurse, an electroradiology technician, a medical physicist, and a radiation oncologist.

How to Prepare for Treatment?

• Shower (do not remove markings)
• Ensure bowel emptying
• Be ready to cooperate with medical staff

What is Associated with the Treatment? So-called withdrawal symptoms may occur, which may include:

• Excessive sweating
• Weakness
• Hot flashes
• Dizziness

After brachytherapy and discharge from the hospital, the patient should contact a doctor in case of any concerning symptoms.

Outpatient and Hospital Care

Brachytherapy can be performed in both outpatient and hospital settings. The decision about hospitalization is made by a radiation oncologist. Patients requiring hospitalization are referred to radiotherapy departments of Affidea NU-MED Group centers.

For patients qualified for outpatient treatment whose place of residence is at a considerable distance from the facility, we offer the possibility of accommodation in nearby hotels with meals and transportation between the place of residence and the medical facility. Accommodation and transportation costs are reimbursed. This solution provides comfort and eliminates the difficulties associated with daily commuting from distant locations.

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