Brachytherapy

Brachytherapy is a type of radiation therapy that minimizes damage done to healthy tissue by administering harmful radiation via a small object placed inside the tumor. This allows the therapy to maintain a narrower focus on tumor growth.


Brachytherapy Diagram

A “seed” is placed into the lung tumor where it lets off radiation, killing local cancer cells.

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 traditional type may be called external beam radiation therapy (EBRT).

Currently, internal radiation is not standard treatment in either lung cancer or mesothelioma, but researchers continue to test the treatment in clinical trials. Results from early studies show potential for brachytherapy to be used to extend life span and reduce the severity of symptoms.

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

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Brachytherapy is administered using 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, a technique known as intraoperative radiation therapy (IORT), or the implant may be inserted into cancer tissue using a hollow tube. In this type of administration, the patient receives local or general anesthesia, and the doctor typically uses the aid of an imaging scan such as a CT scan or ultrasound. Once the implant is in place, it typically only attacks tissue within a radius of 1cm. This can target tumor cells more effectively but requires precision.

This therapy may be combined with other treatments. 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.

The treatment also may be used alongside conventional radiation therapy to attack tumor growth in multiple ways. Depending on each patient's situation and treatments, it may be used as a potentially curative treatment to try to eradicate the cancer, or it may be used as a palliative treatment to reduce symptoms such as coughing and difficulty breathing.

Side effects are minimal in comparison to those of external beam radiation therapy. The most common side effect is tenderness at the site of insertion, which goes away after a few months. Patients may also experience temporary swelling at the treatment site.

Types

There are two 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 a patient receives, he or she 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 (LDR) brachytherapy involves low doses of radiation for long periods of time. For this treatment, radioactive material may be left in place for up to a week.

    The radiation can be harmful to people nearby, so patients remain in the hospital while receiving the treatment. Patients typically stay in private hospital rooms and cannot have guests for extended periods of time. LDR brachytherapy should not be painful or uncomfortable.

  • Permanent

    This is a type of LDR that involves permanently leaving seed implants in the body. This is the most common type used to treat mesothelioma and lung cancer because it has 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, which is then stitched into place during a surgical procedure such as pneumonectomy or pleurectomy/decortication. This type of brachytherapy, designed to kill cancer cells which cannot be removed with surgery alone, actively emits radiation for about three months. Seeds may be mildly radioactive for another year. The inactive seeds then remain in the body permanently.

  • High-Dose Rate

    High-dose rate (HDR) brachytherapy involves high doses of radiation for a maximum of 20 minutes. The patient receives HDR treatment once or twice daily for a series of days or weeks. After the doctor inserts the seed via a tube, he or she typically leaves the room while the radioactive material is in place.

    It does not require a hospital stay and, like LDR brachytherapy, is not painful or uncomfortable.

Study Results

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To date, this therapy has not been studied extensively in mesothelioma patients, and researchers have only conducted small trials with varying results. Doctors have conducted more thorough trials of the treatment in lung cancer patients and have observed better results.

Mesothelioma Studies

A 2005 study treated 123 cases of pleural mesothelioma to test the advantages of the therapy. All patients underwent pleurectomy/decortication and conventional radiation therapy, and almost half additionally received brachytherapy. Researchers concluded that this treatment combination, with or without brachytherapy, was not enough to successfully stop mesothelioma growth.

Despite this study, brachytherapy is still considered a viable treatment option in mesothelioma, and studies continue to test its efficacy. Some treatment centers that specialize in mesothelioma, like Brigham and Women's Hospital, always consider brachytherapy as an option when creating a treatment plan for a mesothelioma patient.

Lung Cancer Studies

Brachytherapy is more successful in treating lung cancer. In one study, 129 lung cancer patients received LDR or permanent brachytherapy. A quarter of these patients survived five years or longer, as compared with only 15 percent of all lung cancer patients.

In other studies, researchers found HDR to be most effective as a palliative treatment for lung cancer patients, easing chest pain and shortness of breath. Studies report that HDR is most effective in reducing symptoms when it is used after external beam radiation. However, HDR still has a limited use because it has not been found to increase life span in lung cancer patients.

Additional Resources

  1. American Cancer Society (2011).Understanding Radiation Therapy: Internal radiation therapy (brachytherapy). Retrieved from http://www.cancer.org/Treatment/TreatmentsandSideEffects/TreatmentTypes/Radiation/UnderstandingRadiationTherapyAGuideforPatientsandFamilies/understanding-radiation-therapy-internal-radiation-therapy
  2. Brigham & Women's Hospital (2011). Mesothelioma: Recent Treatment Innovations. Retrieved from http://www.brighamandwomens.org/Departments_and_Services/surgery/services/thoracicsurgery/services/mesothelioma/Treatments_Recent_Innovations.aspx?
  3. Gupta, V. et al (2005). Hemithoracic radiation therapy after pleurectomy/decortication for malignant pleural mesothelioma. International Journal of Radiation Oncology, Biology, Physics, 63(4), pp. 1045-1052. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16054774
  4. Mayo Clinic (2011). Brachytherapy: Basics. Retrieved from http://www.mayoclinic.com/health/brachytherapy/MY00323
  5. National Cancer Institute (2007). What You Need to Know About Lung Cancer. Retrieved from http://www.cancer.gov/cancertopics/wyntk/lung/wyntk_lung.pdf
  6. National Cancer Institute (2010). Support for People With Cancer: Radiation Therapy and You. Retrieved from http://www.cancer.gov/cancertopics/coping/radiation-therapy-and-you/radiationttherapy.pdf
  7. Surveillance, Epidemiology, & End Results (2012). Cancer Statistics: Fast Stats by Cancer Site. Retrieved from http://seer.cancer.gov/faststats/selections.php?series=cancer
  8. UPMC Cancer Centers (2012). Low-Dose Rate (LDR) Brachytherapy With Vicryl Mesh Implant for Lung Cancer. Retrieved from http://upmccancercenters.com/radonc/lung_mesh.cfm
  9. Yu, E. et al (2011). Lung Cancer Brachytherapy: Robotics-Assisted Minimally Invasive Approach. Current Respiratory Medicine Reviews, 7(5). Retrieved from http://ir.lib.uwo.ca/cgi/viewcontent.cgi?article=1077&context=oncpub

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