How can brachytherapy be carried out

Brachytherapy

What is brachytherapy?

Brachytherapy is a special form of radiation therapy. Brachy means short or close and refers to the short distance between the radiation source and the tumor. In contrast to the usual external radiation therapy, the radioactive radiation source is placed directly on the tumor or inserted into it. This enables targeted irradiation of the tumor area and offers the best possible protection for the surrounding, healthy body tissue. Depending on the indication, brachytherapy can be used as the sole radiation therapy or in combination with external radiation.

In brachytherapy, as in almost all forms of radiation therapy, gamma rays are used, which are created during the natural decay of atomic nuclei. The radioactive radiation released in this way leads to damage or even death of body cells. The extremely rapid growth of many tumor cells makes them more susceptible to radiation than the surrounding tissue.

However, normal body cells can also be damaged during treatment. Especially with radiation from the outside, the rays go through several layers of normal body tissue. Brachytherapy tries to get around this.

What brachytherapy procedures are there?

There are two types of brachytherapy: interstitial and intraluminal brachytherapy.

Interstitial brachytherapy

In interstitial brachytherapy, the radioactive radiation sources are introduced directly into the organ in question. These radiation sources are also called seeds (like seeds that are planted in soil). They are mainly used for prostate cancer, where they remain permanently in the organ after being introduced and thus act on the tumor tissue.

Intraluminal brachytherapy

In intraluminal brachytherapy, the radiation source is introduced into the cavity surrounding the tumor (e.g. the trachea / esophagus) via the applicator. This takes place for the respective period of treatment (minutes) and is then removed again.

Afterloading

Due to the high side effects for the medical staff who were responsible for introducing the radiation sources, the afterloading technique was developed. All equipment is attached and then the radioactive emitters are brought in via the applicators with a computer-controlled feed system.

For which types of cancer can brachytherapy be used?

Basically, due to the type of radiation application, body regions that are accessible from the outside can best be treated. Therefore, the following types of cancer are mainly treated with brachytherapy radiation:

But cancer in other parts of the body can also be treated with brachy radiation. Which includes:

  • Rectal cancer
  • Tumors of the esophagus
  • Tumors of the trachea and bronchi
  • Urinary tract tumors
  • Head and neck tumors
  • Brain tumors
  • Eye tumors

During therapy, the radiation source can be introduced into the body through the respective body opening, so that direct contact with the tumor can be established. This reduces the radiation dose to be applied and shortens the duration of the therapy. An additional advantage is that inpatient treatment is not mandatory. Because the therapy sessions are less frequent, outpatient brachytherapy is often also possible.

How does brachytherapy radiation work

As with any type of radiation therapy, one begins with planning the procedure. Certain information is required for this. Precise knowledge of the extent, type and location of the tumor is essential for this. Therefore, different diagnostic methods have to be used initially. These include x-rays, computed tomography, magnetic resonance imaging and ultrasound, among others.

With the help of the data obtained in radiology, modern data processing can be used to produce three-dimensional images of the respective tumor with precise localization in the body. The optimal distribution of the radiation sources can then be planned in special programs and the radiation doses that hit the tumor and the surrounding tissue can be calculated.

Due to the variability of the radiation positions, the best possible combination can be calculated to prevent so-called hot spots (areas with too high a radiation dose) and cold spots (areas with too low a radiation dose).

If this was successful, the next step can take place: inserting the applicators. The supply system for the radioactive substance introduced later is called the applicator. With the help of the previously calculated image data, the exact position for the applicators in the body can be achieved, where they are then fixed.

At the same time, the radiation therapist creates a treatment plan. This includes, among other things, how much radiation dose will act for how long and how many sessions will be necessary.

What are the advantages and side effects of brachytherapy?

Basically, the less the surrounding tissue and the more the tumor is irradiated, the better. This is the advantage that brachytherapy offers. Unfortunately, this option is not available for all types of cancer, as access via the mouth, anus, vagina or contact with the skin is necessary for skin cancer. The focused irradiation also reduces the risk of recurrence (risk that the tumor will recur).

Despite the precise irradiation of the tumor, radioactive rays always have side effects. During the treatment, swelling, bleeding, discharge, discomfort when urinating, diarrhea and peeling or skin irritation can occur. During this time, medication can help relieve these symptoms. Most of the side effects subside after 4-8 weeks after therapy, when the body cells have had time to regenerate.

In rare cases, permanent disorders of the digestive organs (diarrhea) or the bladder can occur. Irradiation of the breast or skin can also lead to scarring, which makes follow-up treatment necessary.

Regarding the seeds, no special precautions need to be taken. The range of the rays is limited to the organ. People around the world are therefore not exposed to any additional radiation dose.

If the brachytherapy is successful, follow-up examinations will follow at regular intervals. These serve to check the long-term success of the therapy and enable a recurrence of the tumor (relapse) to be recognized as early as possible.

Brachytherapy coverage

The question of whether brachytherapy is generally covered by health insurance companies or has to be paid for yourself cannot be answered unequivocally. It depends on which cancer is being irradiated with brachytherapy, whether the patient is participating in a study and whether the treating doctors recommend brachytherapy. 2 examples show the different ways in which the health insurance companies handle the assumption of costs.

Reimbursement of the cost of brachytherapy for prostate cancer

Brachytherapy for prostate cancer takes place via seed implantation or afterloading. Since the effectiveness of brachytherapy in comparison to other therapy methods has not been clearly proven by studies, the insurance company should clarify whether the costs will be covered in advance.

Reimbursement of the cost of brachytherapy for cervical cancer

Brachtherapy is an established procedure in cervical cancer. If the attending physicians recommend brachytherapy, the costs will be covered by the health insurance companies.

It is therefore advisable to inquire about the reimbursement of costs with the treating doctors and the health insurance company in advance of a brachytherapy treatment.

Swell:

http://www.radioonkologie.insel.ch/de/unser-angebote/zentrum-fuer-brachytherapie/

https://de.wikipedia.org/wiki/Brachytherapie