Brachytherapy cancer (prostate, uterus)
Brachytherapy is a modern and very effective method of radiation therapy that are actively used in Oncology for tumor diseases of the cervix, prostate, rectum, esophagus and other organs.
Radiation therapy is used in Oncology for a long time and in a variety of tumors. It considers the main methods of dealing with malignant tumors, but complications and possible side effects limit broad use of irradiation, especially in patients were children or elderly, when the risk of adverse adverse reactions the most high.
Search safer treatments than remote radiotherapy, has led to developing methods of local radiation exposure minimizing the radiation effect on the surrounding tissue and allowing to use it in higher doses. Such methods include brachytherapy, which quickly gained wide circulation in Europe, USA, Russia, thanks to the effectiveness and relative safety.
The advantages and types of brachytherapy
Attempts to perform irradiation directly in the area of tumor growth were made a century ago, when American doctors has proposed to introduce a capsule with radioactive radium into the prostate tissue. Later, the source of radiation delivered to the tumor by trocar. A significant drawback of the proposed procedures was the treatment blind, as there was no way to trace the path and the end point of the location of the emitter.
With the development of medical equipment, the implementation in practice of doctors of ultrasound and computed tomography in the accurate implantation of radioactive agent was resolved. Under the control of ultrasound was able to achieve a uniform distribution of the radionuclide in the tissue, and the method became the basis of modern brachytherapy.
Since the second half of the last century began to spread cavitary brachytherapy. The effect was pretty good, but the downside was the exposure the doctors themselves. To overcome this factor by physicists in conjunction with the radiologists has developed devices for automated injection of radioactive substances in the tissue, as well as special containers for their storage, eliminating the radiation effect on the personnel of the offices of radiation therapy.
Today brachytherapy is a widely used and very effective way of dealing with cancer, especially heavily used for tumors of the prostate. More recently, some forms of the disease only demanded radical measures are impossible in some patients, but they’ve been replaced by local irradiation.
Brachytherapy has several advantages compared with conventional external radiotherapy when the unit is outside of the patient’s tissue. These include:
- The possibility of using higher doses of radiation without damage to the whole body;
- The local effect of the radiation only in the area of neoplastic growth with minimal contact with other tissues;
- The ability of a single injection of radioizlucheniya;
- Less than with external radiotherapy, the number of side effects;
- Long relapse-free period;
- Short rehabilitation;
- The possibility of repeated brachytherapy in case of relapse.
Depending on the technique of the procedure, brachytherapy is:
Intracavitary brachytherapy is applicable for neoplasms in those organs which have a cavity or lumen of the bronchus, stomach, uterus and others. For the procedure of radiation in the cavity is placed a special applicator, which is fixed radioactive emitter.
Interstitial (interstitial) brachytherapy is indicated for the destruction of tumors of organs that are not hollow, and are mainly parenchyma. In the tumor field, enter the radioactive element in the form of needles or grains.
Intravascular brachytherapy is used less frequently than interstitial because not every clinic can afford such complex and expensive equipment and training of highly qualified specialists. In addition, the disadvantage is the likelihood of personnel exposure that requires the use of highly effective remedies. Intravascular irradiation has been used not so much in Oncology, as in vascular surgery, as it gives a good result in the treatment of re-stenosis of coronary arteries. This treatment is successfully and widely used worldwide.
It is no secret that many oncologic interventions lead to permanent disability, loss of parts or even the whole organ. Example ophthalmology, where the tumor can result in patient loss eyes that will significantly affect the quality of life in the future. In this case, brachytherapy can be considered organ-saving treatment, which will not only remove the tumor but also to maintain a high level of adaptation in the future.
Emitting radionuclide may be placed in the tumor tissue manually or with an automated system. During an unattended installation of the radiator there is no need to contact clinic staff, it makes the machine that delivers special capacitance of the radionuclide in the tissue and then, after a period of exposure, he himself removes it. For automated brachytherapy uses a modern system Microselectron, Gammamed, agate (domestic production), which are equipped with large oncological centers of Russia and CIS countries.
Depending on time, which will hold the radionuclide in the tissues of the patient, there are:
- Temporary brachytherapy;
Under the provisional irradiation, the radionuclide is implanted in the tissue of tumors at a certain time, after which it is deleted. Permanent brachytherapy is a single room in fabric or radioactive seed capsules that remain there forever. The choice of method depends on the emitting agent. If the emitter is terminated by the end of the planning period of exposure, giving the required amount of energy to tissues, then there is no need to repeat the manipulation on removing it, and leaving it quite safe for life and health of the patient.
Video: brachytherapy, how it’s made?
Modalities of brachytherapy and preparation of the patient
Brachytherapy requires the participation of a whole team of specialists – oncologists, surgeons, radiologists, physicists, dosimetrists, working together to determine the exact installation location of the radioelement, the duration of treatment, cumulative dose. Physics run sophisticated equipment and help the doctor to act according to the developed scheme of treatment.
Currently, brachytherapy uses a variety of radioactive elements – iodine, iridium, cesium and palladium. In permanent brachytherapy, these elements are introduced into the composition of capsules or beans, surrounded by a protective metallic layer that prevents irradiation of the neighboring tissues. In the event of a temporary exposure of the used needle or conductors on which capacity at some time delivered to the tumor tissue, and then it is removed. Assistance in the care of these devices provides the nurse of the radiology Department.
To enter the radiation source in the organs of the patient is possible only after accurate calculation of the dose, place of administration and of the way in which the item reaches the tissue. For a more precise implantation is applied ultrasound, computed or magnetic resonance tomography, as well as automated delivery system and calculation of cumulative dose.
Preparation before brachytherapy depends on the type of procedure and characteristics of the disease. All patients shown General clinical examination (blood, urine), ECG, x-ray of the chest, a mandatory control CT scan, MRI, ultrasound. Before implantation of the emitter can be administered sedatives, analgesics, or even be implemented by anesthesia (depending on the insertion site and the desired scope of intervention).
Applications of brachytherapy
Brachytherapy is used in gynecological practice in cancer of the uterus, when the emitter set into the body. Thus, high dose exposure locally, and the treatment gives you the opportunity to save the uterus, which is very important for young patients. Other applications of the local irradiation cancer of rectum, esophagus, bronchus.
The most active brachytherapy is assigned in Onco-urology in the treatment of prostate cancer amongst all cancers in men ranked first in frequency and second in mortality. The detection of pathologies requires a radical intervention, prostatectomy, and a good alternative to him was brachytherapy, which is especially justified in the treatment of men a young age.
Brachytherapy for prostate cancer is shown in the initial stages of the tumor, when there are metastases, there was no proliferation of the carcinoma into the surrounding tissue. Methods of brachytherapy practice in different clinics may vary, but they all conform to the recommendations of the American society of brachytherapies.
Recommendations of this society include the indications for brachytherapy, used to describe radioactive elements, methods of selecting the optimal dose. Experts defined maximum permissible radiation exposure, the risk groups among patients.
In brachytherapy of the prostate all patients performed dosimetric planning with the calculation of the exact dose before or during implantation of radioactive emitter. It is compulsory to control the treatment after 4-6 weeks after graduation.
To more accurately determine the size, location of the tumor, the site of the proposed implantation of radioactive particles using CT, MRI, ultrasound control. The most accurate and available consider a transrectal ultrasound and CT. If you are using computed tomography scanning should be performed a few days before the planned procedure. CT can be supplemented with contrast injection.
After brachytherapy oncologist will present the patient with a list of recommendations concerning lifestyle and possible emergency situations associated with the radiation emanating from the patient.
During permanent brachytherapy, the emitter stays in the prostate for life, so it is not surprising that the patient for some time may be the source of the radiation. In order to assure compliance with radiation safety physicist of the clinic before discharge making control measurements of radiation and records them in the statement.
The intensity of radiation within a radius of 1 metre around the patient should not be more than 10 µsv/HR, this figure is considered to be safe to others, close relatives, family members. The radiation is registered not more than six months since implantation, the radiating element (typically iodine, half-life is 60 days).
Certain difficulties associated with radioactive capsules that can occur at airports, railway stations, certain facilities, which includes a control dosimeter or detector. Both the device will announce a signal of presence of metal and radioactive objects in a body, and the person may be unduly delayed. To avoid such incidents, the clinic issued a statement, perhaps in English, to travel abroad.
Recommendations for the first two weeks after brachytherapy:
Men who had undergone implantation of radioactive particles, banned for the first 2 months after surgery to put on the knees of children, as well as to be in close prolonged contact with pregnant women. It is associated with a higher risk from radiation for the health of babies and expectant mothers, so this is if not to exclude, to limit.
The first two years after brachytherapy should be careful when you assign other treatment for diseases of other organs. This is especially true of the ability of physical therapy, which is contraindicated in many patients.
If the patient prostate cancer to brachytherapy underwent transurethral resection or other types of operations, i.e. the probability of radioactive release capsules out. Action in such a situation is usually specified by the attending physician or physicist. As capsule continues to emit radiation, you should not take in hand, better to do it with tweezers or any improvised means. Further, the radiation source should be placed in a container, away from children, and take for disposal in the clinic.
After a half to two months after surgery, you may return to a normal way of life, the gradual expansion of the prohibitions indispensable to consider what the losing of swelling of the prostate return to normal size (on CT, MRI, ultrasound). You can also start physical exercises, go swimming, plan career.
For reviews of patients, the implantation procedure radiocaster and subsequent rehabilitation are painless and quite well. Especially noted short rehabilitation period and the ability to return home even the next day. With all the recommendations, the risk of complications is almost zero.
Among the complications of brachytherapy for prostate cancer possible dizuricheskie disorder (1% of cases), acute urinary retention (5%) and pain syndrome, inflammation of the bladder and urethra, to eliminate which resort to catheterization of the bladder, the appointment of painkillers, antibiotics. These early complications usually resolve within the first 2-3 months after treatment.
Posledstvia brachytherapy – stricture of the urethra that can occur during the first 5 years after treatment and found in every tenth patient. Impotence is possible, but it is associated rather than with brachytherapy, and by the cancer and previous treatment of disorders of sexual function.
Brachytherapy – a procedure complicated, requiring expensive equipment and teams of highly skilled professionals, so may not be cheap. The price is determined by the method of operation, equipment and level of the clinic. Abroad it reaches 10-15 thousand euros, in Moscow varies in the range of 300-500 thousand rubles, but not less than 100 thousand rubles, taking into account the cost.
The citizens of Russia treatment can be carried out free of charge, in particular, at Obninsk Center of brachytherapy, due to the Federal budget. Of course, there is a certain place, and to get the treatment you need to provide the survey results (CT, MRI, PSA, etc.), as well as the insurance policy or insurance certificate from the Pension Fund.