What is High Dose Rate Brachytherapy?

High dose rate brachytherapy, also referred to as HDR brachytherapy, is a type of radiation therapy that eliminates cancer cells by making it difficult for them to proliferate (increase or multiply). It is an advanced cancer treatment that involves placing radioactive material inside or close to the tumor to deliver a highly concentrated dose of radiation to destroy cancer cells while sparing the surrounding healthy tissue.

Brachytherapy allows physicians to deliver higher doses of radiation to more-specific regions of the body, compared with the traditional form of radiation therapy (external beam radiation) that sends out radiation from a device outside of the body. Brachytherapy may cause fewer side effects than external beam radiation, and the overall treatment time is typically shorter with brachytherapy. Brachytherapy can be used alone or in conjunction with other therapies such as chemotherapy, external beam radiotherapy (EBRT), and surgery.

Indications for High Dose Rate Brachytherapy

High dose rate brachytherapy is employed to treat various types of cancer, including:

• Prostate cancer
• Cervical cancer
• Endometrial cancer
• Vaginal cancer
• Rectal cancer
• Breast cancer
• Soft tissue cancers

In men, it is commonly used in the treatment of prostate cancer. It is most appropriate for men whose cancer has not metastasized (spread) outside the prostate gland (localized prostate cancer) and has been classified as CPG2 /CPG3 (medium) or CPG4 / CPG 5 (high risk) of metastasizing outside the prostate or coming back after treatment.

Preparation for High Dose Rate Brachytherapy

Pre-procedure preparation for high dose rate brachytherapy may involve the following steps:

• A review of your medical history and a physical examination are performed by your doctor to check for any medical issues that need to be addressed prior to the procedure.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and scans such as X-rays, computerized tomography (CT), or magnetic resonance imaging (MRI) to determine your treatment plan.
• You should inform your doctor of any medications or dietary supplements you are taking or have any heart device such as a pacemaker.
• You may be asked to refrain from certain medications such as blood thinners or supplements that affect blood clotting for at least a week prior to the procedure.
• You should also inform your physician if you have allergies to medications, anesthesia, or latex.
• You should refrain from alcohol or tobacco at least a few weeks before treatment you may be at risk for complications during and after your procedure. These include breathing problems, infections, heart problems, and a longer hospital stay.
• You may be advised by your physician to follow a special diet before, during, and after radiation therapy. You are advised to have a comfortably full bladder and an empty rectum (bowel) prior to the procedure.
• You need to arrange for someone to drive you home after the procedure.
• A signed informed consent form will be obtained from you after the pros and cons of the procedure have been explained.

Procedure for High Dose Rate Brachytherapy

High dose rate brachytherapy treatment is an outpatient procedure performed under anesthesia and involves placing a radioactive material directly into or close to a tumor. How your physician places that radioactive material in your body depends upon many factors, such as the extent and location of cancer, your overall health, and your treatment goals.

During the high dose rate (HDR) brachytherapy procedure, a protected source of high energy radiation is placed in the area of a tumor such as the prostate and utilizing specially designed applicators, such as radioactive tubes, needles, wires, plaques, or small "seeds" made of radionuclides. These radioactive materials are positioned over the surface of the tumor or implanted within the tumor or placed within a body cavity surrounded by the tumor. To make the patient more comfortable, relaxing or pain medication is commonly provided prior to the procedure. Once the applicator is placed, imaging is performed to verify correct placement and for treatment planning. An individualized treatment plan is designed, and a high dose rate radiation is delivered for a short duration to destroy cancer cells and shrink tumors. Following treatment, the applicator is removed. The treatment session may last for a few minutes up to twenty minutes. You may need 1 or 2 sessions a day over a number of days or weeks.

Post-Procedure Care and Recovery

In general, post-procedure care instructions and recovery after high dose rate brachytherapy will involve the following steps:

• You will be transferred to the Post-Anesthesia Care Unit (PACU) where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
• You may experience pain, inflammation, and discomfort around the treatment area. Pain and anti-inflammatory medications are provided as needed for comfort.
• Urinary symptoms are the most common side effects of brachytherapy. These include urinary urgency, urinary frequency, and burning with urination. Medications are prescribed as needed to manage these side effects.
• You should be able to resume your regular diet after the procedure. 
• You will be discharged on the same day of the procedure as brachytherapy is an outpatient procedure.
• You will need to resume your activity level gradually. Do not engage in strenuous activities or lift anything over 20 pounds for at least a week after your procedure.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

High dose rate brachytherapy is a safe procedure; however, as with any procedure, there are risks and complications that can occur depending on the location of treatment, such as:

• Pain, swelling, and soreness
• Allergic/anesthetic reactions
• Infection
• Bleeding
• Urinary problems
• Erectile dysfunction
• Other sexual problems
• Bowel problems