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High Dose Rate (HDR) and Permanent Seed Brachytherapy

Brachytherapy is a method for delivering radiation from the inside out using either a removable or implantable radioactive source. The Radiation Oncologists at Avera Cancer Institute are some of the most experienced in the Midwest in both High Dose Rate (HDR) and Permanent Seed Brachytherapy, two distinct but equally important techniques. Our doctors not only have specialty training in these procedures, but have also successfully used them to treat thousands of area cancer patients.

Because it involves directly placing a radioactive source in or near a tumor, brachytherapy provides a high level of treatment precision for certain types of cancer. And because the radiation stays so close to the treatment area, the chance of damaging the healthy surrounding tissue is low. Most brachytherapy patients have no major side effects.

Multiple Applications

Depending on the type of cancer, doctors may place the radioactive source near the tumor through a single port or using a multichannel system. In some cases, the source is removed after some time. In other cases, the radioactive “seeds” are left in place in the body, where their radioactivity eventually dissipates.

Brachytherapy may be used alone or in combination with other cancer treatments such as chemotherapy or external beam radiotherapy.

What Can Be Treated with Brachytherapy?

Using specialized tools and techniques, Avera Medical Group Radiation Oncologists can provide brachytherapy treatment for a variety of cancers including:

  • Bile Duct or gallbladder
  • Breast
  • Lung
  • Gynecological
  • Prostate
  • Some head and neck cancers

Breast cancer

Brachytherapy treatment for breast cancer

For breast cancer patients who have undergone lumpectomy, brachytherapy can help keep cancer from returning by treating it right at the source. A form of partial breast irradiation, breast brachytherapy involves placing a radioactive “seed” inside the lumpectomy cavity, essentially treating any residual cancer cells from the inside out.

At Avera Cancer Institute, our Radiation Oncologists have specialty training in an advanced brachytherapy system called Contura after its ability to mold itself to the irregular shape of the lumpectomy cavity. Breast brachytherapy treatments are performed in a dedicated HDR Brachytherapy Suite.

How Does Breast Brachytherapy Work?

During treatment with the Contura Multi-Lumen Balloon Breast Brachytherapy system, a small inflatable device is placed into the lumpectomy cavity through a catheter and filled with saline. A vacuum system is used to gently adhere the balloon to the cavity.

Next, based on the treatment plan developed by your Radiation Oncologist, a radioactive “seed” is sent from a computer controlled machine into the cavity through five separate “lumens” or channels. The multi-channel design allows the radiation dose to penetrate all sides of the cavity and destroy any cancer cells that may have been left behind after surgery.

Advantages of Breast Brachytherapy

  • Unlike traditional radiotherapy for breast cancer which can take weeks, breast brachytherapy is fast. It is administered twice a day for just five days.
  • Partial Breast Irradiation helps keep radiation away from the skin, chest wall and ribs.
  • Breast brachytherapy causes little or no discomfort.
  • Side effects are mild and may include redness, bruising or breast tenderness.
  • When treatment is done and the catheter removed, the small incision can be closed with a sterile bandage.

Who is a Candidate for Breast Brachytherapy?

Breast brachytherapy is typically used to treat patients who have early-stage breast cancer. In addition, good candidates have

  • Surgical margins clear of cancer
  • No evidence of cancer in the lymph nodes
  • A tumor smaller than 3 centimeters in diameter
  • Estrogen-receptor positive cancer

If lumpectomy and radiation is recommended for your cancer, your comprehensive cancer care team at Avera Cancer Institute will help you decide if breast brachytherapy would be a good treatment option.

Prostate cancer

Brachytherapy treatment for prostate cancer

Prostate Cancer is one of the most time-tested and proven applications for Brachytherapy. At Avera Cancer Institute, our Radiation Oncologists are pioneers in the field of brachytherapy, having used this technology since its development more than 15 years ago to successfully treat hundreds of prostate cancer patients.

Also known as Permanent Seed Brachytherapy, Prostate Brachytherapy involves the implantation of tiny radioactive seeds, about the size of a grain of rice, into the prostate where they emit their DNA-damaging radiation over a period of two to six months. The Avera Cancer Institute uses the VariSeed Prostate Treatment Planning System, the most trusted treatment planning system for prostate brachytherapy in the world.

Like other forms of brachytherapy, the advantage of Permanent Seed Brachytherapy is its ability to deliver a powerful dose of radiation at the site of the cancer with less damage to healthy tissue nearby.

How Does Permanent Seed Brachytherapy Work?

Permanent Seed Brachytherapy for prostate cancer begins with a series of treatment planning images obtained with a Trans Rectal Ultrasound Imaging system (TRUS). Using this “map” of the prostate, the Radiation Oncologist, along with physicists and dosimetrists, can determine the ideal number and distribution of radioactive seeds. Some cases may require as many as 200.

Using needles and TRUS guidance, the Radiation Oncologist carefully inserts each seed into the prostate. The procedure takes one to two hours and patients can usually go home a few hours later. Because the radioisotopes (I125 and Pd103) used for Permanent Seed Brachytherapy are low energy, they gradually lose their activity and can safely stay in the prostate permanently.

Risks and Side Effects

Even though radiation does not travel far with Permanent Seed Brachytherapy, some patients experience temporary urinary problems and irritation because of the prostate’s proximity to the urethra. Other side effects may include:

  • Irritation at the needle insertion site
  • Rectal wall irritation
  • Incontinence
  • Rare changes in sexual function

Who is a Candidate for Permanent Seed Brachytherapy?

Because of the limited reach of the seeds’ radioactivity, the best candidates for Permanent Seed Brachytherapy are men with early stage cancer in which tumors are small and confined to the prostate.

Skin cancer

Brachytherapy treatment for skin cancer

The treatment of skin carcinomas with brachytherapy was one of the first medical uses of radiotherapy and dates back as far as the early 1900’s. At the Avera Cancer Institute, our Radiation Oncologists have specialized training in skin cancer brachytherapy techniques, including the use of a custom moldable surface applicator called the Freiburg Flap Applicator.

Since many skin cancers occur on sun exposed areas like the head or face, brachytherapy may be used as an alternative to surgery for a better cosmetic result. It may also be a good option for patients who are too fragile to undergo cancer surgery. Brachytherapy has been shown to help keep cancer from returning.

How Does Skin Brachytherapy Work?

Like other forms of brachytherapy, brachytherapy for skin cancer works by placing a radioactive source in close contact with the targeted cancer cells. During treatment, the small radioactive sources are fed into an applicator on the skin by an advanced computer-controlled machine called an afterloader. The ability to custom mold the applicator gives our Radiation Oncologists the flexibility to offer brachytherapy for tumors of many shapes and sizes.

Brachytherapy Advantages

Although skin cancer can also be treated with external beam radiation, brachytherapy offers some distinct advantages including

  • Reduced treatment time, usually 1 to 2 weeks of every-other-day treatments
  • Better cosmetic results than surgery
  • Protection against future skin cancer recurrence
  • Painless Treatment

Who is a Candidate for Skin Brachytherapy

Patients with basal call or squamous cell carcinomas that have not spread to other parts of the body may be candidates for skin brachytherapy.