Brachytherapy for Mesothelioma

What Is Brachytherapy?

Unlike traditional radiation therapy, brachytherapy uses no external radiation. Because of this defining property, it may also be referred to as internal radiation therapy, whereas the conventional type may be called external beam radiation therapy.

Internal radiation isn’t standard for lung cancer or mesothelioma, but researchers continue to test the treatment in clinical trials. Results from early studies show the potential for brachytherapy to extend life span and reduce the severity of symptoms. A March 2021 study reported thoracic cancer patients who receive brachytherapy benefit from fewer and less severe side effects after pulmonary surgery.

So far, it has been more effective in treating lung cancer. Researchers saw the best results for both types of cancer when they implemented a treatment called permanent brachytherapy. With this therapy, radioactive material is placed permanently into the tumor site and this material slowly loses its radioactivity over a few months.

Expert Take

Dr. Velotta: Mesothelioma Cryoablation for Surgical Pain

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The idea of cryoablation, what is cryoablation? It’s just like cryotherapy, it’s freezing, Freezing of things.


There’s been For decades, people have froze different areas. For example, the heart for atrial fibrillation. It’s the same thing, except we’re freezing the nerves. We’re extrapolating that data to actually freeze the nerves that go in between your ribs for five levels above and below the incision to cover the majority of your chest, and it will cover all of those levels on that side.


We freeze the nerve for a minute per nerve, and you’re asleep. This is during your surgery. The idea is you render the nerve inactive where it becomes numb. So instead of intense pain and shooting pain from me cutting open where it really hurts, like it feels like a rib fracture almost, you just feel numb in that area.


It’s not perfect where, oh my gosh, you’ll not need any pain medication. We have data on it, I’ve done it on twenty five patients already. It’s a fairly new thing for meso and this is just in the mesothelioma surgery, that patients are taking in less narcotics, needing less opioids, but at the and at the same time having no side effects from it. There’s no complications from it.


You can expect to feel numb in that area for about two to three months, then the nerves come back and you start to feel normal again.


So we substitute pain for numbness. And I’ll tell you every patient that I ask for that, because I do talk to them before about that, they’ll always take numbness when they’re instead of intense pain. I will. I mean, any of us will. But I do explain that.


It’s not that you’re gonna feel no pain, it’s that it’s gonna be that numb feeling in there. Whatever we can do in the field, it’s not just related to mesothelioma surgery, any surgery, of trying to find out what good pain adjuncts that will reduce the amount of opioid derivatives, are morphine and Dilaudid and Oxycodone, all the things we talk about in addiction and all that. My patients are saying, the pain is not that bad anymore. And so think about that.


When I talk to patients now about pain, I’m not as like Debbie Downer or as negative about it. I used to say, hey, the pain’s gonna be terrible, And That would scare some people away. But now I say, yeah, the pain’s gonna be rough. It’s gonna be one of those situations where yes, will have pain, yes, you will need pain medication, but with the new freezing of the nerves that I do on all these patients, I’ve seen they’ll ask me how many patients.


Twenty five patients that I’ve done it on so far.


Those patients all have done so much better than the patients that didn’t have that when look back and when I talk to them. Regardless of waiting for the paper or the research to come out, I ask the patient afterwards. Our patients, we ask the patients during, while they’re in the hospital, are you feeling pain? How is the pain?


And then we ask them specifically, are you feeling numb? They’ll say, yeah, have a little bit of pain, but I feel more numb. When you’re feeling numb, we know it works. So that’s the difference with cryoablation.


Before we had the freezing, you would just feel pain or a lot of pain or a little bit of pain. Now it’s Pain? Pain or it feels numb.


And then numb, if you’re feeling numb, you’ve done it right. The idea, again, frees the nerve right at the location a minute per nerve. For five nerves above and below the incision where all the work’s being done. I think that’s really gonna revolutionize the future of more patients will be amenable to surgery, more patients will have a better recovery from surgery, and a better quality of life afterwards.

How Is Brachytherapy Performed?

Brachytherapy uses a radioactive material called an implant. The material may come in the form of a wire or a “seed” about the size of a grain of rice.

It may be placed during surgery with an intraoperative radiation therapy technique or it may be inserted into cancer tissue with a hollow tube. With IORT, the patient receives local or general anesthesia and the doctor typically uses an imaging scan such as a CT or ultrasound.

Once the implant is in place, it commonly only attacks tissue within a radius of 1cm. This can be more effective but requires precision.

IORT brachytherapy is always administered in conjunction with surgery, and some lung cancer patients receive standard brachytherapy after surgery to kill any remaining cancer cells. It may also be used alongside conventional radiation therapy to target tumor growth in multiple ways. It may be used as a potentially curative treatment to eradicate cancer or as a palliative treatment to reduce symptoms such as coughing and difficulty breathing, depending on the individual patient’s situation.

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Types of Brachytherapy

There are 2 primary types of brachytherapy: Low-dose rate and high-dose rate. People with lung cancer or mesothelioma usually receive a form of low-dose-rate treatment called permanent brachytherapy. This type continuously attacks the tumor with radiation for several months.

Depending on the type of therapy patients receive, they may undergo treatment for up to several weeks. This is shorter than the time needed to complete an external beam radiation therapy regimen, which can take up to 10 weeks.

Low-Dose Rate

Low-dose rate brachytherapy involves low doses of radiation for long periods. Radioactive material may be left in place for up to a week for this treatment.

The radiation can harm people nearby, so patients remain in the hospital while receiving LDR brachytherapy. Patients typically stay in private hospital rooms and can’t have guests for extended periods. LDR brachytherapy shouldn’t be painful or uncomfortable.

Permanent

This type of LDR involves permanently leaving seed implants in the body. This is the most common type used to treat mesothelioma and lung cancer because it has the most improved patient survival rates in clinical trials.

Typically, the implant is inserted during surgery as a form of IORT. Radioactive seeds are woven into a flexible mesh and stitched into place during a surgical procedure such as pneumonectomy or pleurectomy/decortication. This type of brachytherapy, designed to kill cancer cells that can’t be removed with surgery alone, actively emits radiation for about 3 months. Seeds may be mildly radioactive for another year. The inactive seeds then remain in the body permanently.

High-Dose Rate

High-dose-rate brachytherapy involves high doses of radiation for a maximum of 20 minutes. The patient receives HDR treatment once or twice daily for several days or weeks. After the physician inserts the seed via a tube, they typically leave the room while the radioactive material is in place. It doesn’t require a hospital stay and, like LDR brachytherapy, isn’t painful or uncomfortable.

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Side Effects of Brachytherapy

The most common side effect is tenderness at the site of insertion, which subsides after a few months. Patients may also experience temporary swelling at the treatment site. Due to the sharp radiation dose fall-off with brachytherapy, it may be associated with fewer side effects than external beam radiation therapy in some cases.

Regardless of cancer type, brachytherapy can also cause skin irritation, such as redness, dryness, sensitivity or darkening under the breast or arm. In more severe cases, the skin may peel or develop moist ulcers. Doctors can prescribe prescription ointments that help relieve many of these side effects.

Most side effects usually go away after treatment ends, but you may feel very tired for 4 to 6 weeks after your last treatment. If symptoms worsen or don’t resolve with medications, your oncologist may refer you to a specialist to diagnose or further treat the problem.