Brachytherapy (Internal Radiation Therapy)

Some types of brain cancer, including glioblastomas, gliomas and meningiomas, are treated with a combination of brachytherapy and surgery. During surgery, your surgeon will remove as much of the brain tumor as possible. Then, special radioactive seeds or an implant that looks like a small, square tile is placed into the brain to deliver radiation therapy, helping prevent any remaining cancer cells from growing.

With this method, most of the radiation is delivered within the first several weeks after your brachytherapy is placed. After about 100 days, the implants will no longer give off any radiation. During these first few months, you may need to take steps to avoid close contact with some people, such as children or someone pregnant, to limit the small chance of exposing them to radiation.

In breast cancer, brachytherapy is often combined with lumpectomy—which is surgery to remove the lump or area of cancer in the breast while leaving healthy breast tissue. It is usually only recommended for certain early-stage breast cancers and is not an option for those who need a mastectomy or when cancer has spread to the lymph nodes.

Whole breast irradiation delivers radiation externally to the entire breast and often requires several weeks of treatment. However, brachytherapy is a way to deliver radiation to the specific area where a tumor is located without the need for weeks of radiation therapy visits. It can be delivered in a few ways, such as with catheters, a balloon applicator or during surgery.

Intracavitary breast brachytherapy

After a lumpectomy, intracavitary breast brachytherapy is an option. It uses a single catheter with a balloon that is placed into the area of the breast where the tumor is located. This balloon can then be inflated, and your team delivers radiation into it for up to 10 minutes. Like interstitial breast brachytherapy, this type of brachytherapy is typically used to provide a high dose of radiation twice a day for five days.

The most common type of brachytherapy for earlier stages of cervical cancer is called intracavitary brachytherapy. It’s often used along with external beam radiation. In those who have had a hysterectomy, radioactive material is put in a tube that’s placed inside the vagina. For those who haven’t had their uterus removed, a tube or disc may be placed inside or near the uterus.

With this type of brachytherapy, you may have high-dose rate brachytherapy, where high doses of radiation are placed in the tube for only a few minutes at a time. HDR brachytherapy requires several treatments but does not require a hospital stay. Less commonly, you may have low-dose rate brachytherapy, where the radioactive material is left inside the body for a few days while in the hospital.

In endometrial cancer, brachytherapy is sometimes used as a treatment after you have your uterus and cervix removed. It targets any cancer cells in the upper part of the vagina. During treatment, your care team places a tube that contains radioactive material inside the vagina.

Most of the time, this will be done as an outpatient procedure, where the tube is only left inside the vagina for a few to several minutes at a time. Depending on your care plan, you might have these brachytherapy treatments weekly or twice a week.

In lung cancer, brachytherapy is most often a treatment option for non-small cell lung cancer, especially when it’s located in the bronchi, which is a major airway in the lung. Your doctor can place radioactive material into the area of cancer using endobronchial brachytherapy or surgery.

During endobronchial brachytherapy, your doctor uses a bronchoscope inserted through the nose down into the airways. Then, a catheter is inserted to allow your care team to deliver the radiation source into the right place. This treatment usually lasts for a few minutes or up to 15 minutes.

When your team places radioactive seeds as a part of surgery, they may be left in the lungs permanently. The goal is to stop any remaining cancer cells from growing after a tumor is removed. Over time, the seeds will no longer give off radiation.

When prostate cancer is still localized, brachytherapy may be an alternative to surgery to remove the prostate. Sometimes, you may have only brachytherapy, or it can be combined with other treatments like hormone therapy or external beam radiation therapy.

The most common type of brachytherapy for prostate cancer is low-dose rate brachytherapy. It permanently implants dozens of small radioactive seeds into the prostate. These seeds then give off radiation over weeks or months until the radiation eventually stops.

High-dose rate brachytherapy—where higher doses of radioactive material are placed temporarily—may also be an option in prostate cancer. However, it isn’t as common.

For non-melanoma skin cancer, brachytherapy can provide an alternative treatment option to surgery. Your healthcare provider may recommend this option when your cancer is located on areas of your face, as it can preserve natural features and avoid the need for reconstruction surgery.

Depending on the location of your skin cancer, your care team can create custom-made molds during the treatment planning process and use several different applicators. These help your doctor precisely deliver high-dose rate brachytherapy to the specific area of cancer.

Brachytherapy is sometimes used after surgery in the treatment of uterine cancer. First, you’ll have surgery to remove the uterus—a hysterectomy. Then, a tube is placed into the vagina to deliver radiation therapy directly into the upper area of vaginal tissue.

If low-dose rate brachytherapy is used, then the tube is left in the vagina for a few days while you stay in the hospital on bed rest. High-dose rate brachytherapy uses more intense radiation delivered through the tube for a short time. This type of outpatient procedure typically requires about three treatments.

If your care team recommends radiation therapy for vaginal cancer, usually, you will have a combination of brachytherapy and external beam radiation therapy. The most common type of brachytherapy for vaginal cancer is intracavitary brachytherapy.

With low-dose rate intracavitary brachytherapy, a tube containing radioactive material is inserted into the vagina and left in place for a couple of days. It requires you to stay on bed rest in the hospital. With high-dose rate intracavitary brachytherapy, the tube is placed for a short time during an outpatient procedure. You’ll usually have a few of these treatments every one to two weeks.