Name of the Procedure:

High Dose Rate Electronic Brachytherapy, Interstitial or Intracavitary Treatment, Per Fraction, includes Basic Dosimetry

Summary

High dose rate (HDR) electronic brachytherapy is a type of radiation therapy where a high dose of radiation is delivered to a localized area within the body. The procedure uses a portable electronic source of radiation, which is placed either within (intracavitary) or directly into (interstitial) the treatment site. This is typically done in fractions or separate sessions, and basic dosimetry, or radiation dose calculation, is included in each session.

Purpose

HDR electronic brachytherapy is used to treat various types of cancer, including prostate, cervical, breast, and skin cancers. The goal is to target cancerous tissues with high precision while minimizing exposure to the surrounding healthy tissues. This targeted approach can reduce treatment times and side effects compared to traditional radiation therapy.

Indications

• Patients diagnosed with specific types of cancer (e.g., prostate, cervical, breast, skin).
• Tumors located in areas that can be accessed for interstitial or intracavitary placement.
• Patients requiring a focused radiation dose to reduce damage to surrounding healthy tissues.

Preparation

• Patients may need to undergo various imaging tests such as CT, MRI, or ultrasound scans to determine the exact location and size of the tumor.
• Fasting for a certain period before the procedure may be required.
• Adjustments to medications, especially anticoagulants, may be necessary.
• Informed consent will be obtained, and patients will receive detailed instructions from their healthcare provider.

Procedure Description

1. The patient is positioned comfortably, and the treatment area is prepped.
2. Using imaging guidance, the applicator or catheter is inserted either into a body cavity or directly into the tumor tissue.
3. The HDR electronic brachytherapy device is then connected to the applicator.
4. The pre-calculated radiation dose is delivered through the applicator to the targeted area.
5. Continuous monitoring ensures the precise amount of radiation is administered.
6. After the dose is delivered, the applicator and device are carefully removed.
7. The procedure may include multiple fractions, each delivered in separate sessions.

Duration

Each session typically lasts about 15 to 30 minutes, although setup and preparation can take additional time.

Setting

The procedure is often performed in a dedicated radiation therapy suite within a hospital or outpatient clinic.

Personnel

• Radiation oncologist
• Medical physicist
• Radiation therapist
• Nursing staff

Risks and Complications

• Minor to moderate pain or discomfort at the treatment site
• Skin irritation or changes if the treated area is near the skin
• Infection or bleeding at the insertion site
• Rarely, unintended radiation exposure to surrounding tissues
• Tissue damage or scarring in the treated area

Benefits

• High precision targeting of cancerous tissues
• Minimal exposure to surrounding healthy tissues
• Shorter treatment times compared to traditional radiation therapy
• Reduced side effects in many cases

Recovery

• Patients are usually able to go home the same day as the procedure.
• Post-procedure care may include pain management and wound care if there was an insertion site.
• Most patients can resume normal activities within a day but should follow specific instructions from their healthcare provider.
• Follow-up appointments to monitor the treatment's effectiveness and any side effects.

Alternatives

• External beam radiation therapy (EBRT): Non-invasive but may affect a larger area of healthy tissue.
• Low dose rate brachytherapy: Involves placing radioactive seeds in the body, offering sustained treatment over a more extended period.
• Surgical removal of the tumor: More invasive with a longer recovery period.
• Systemic therapies such as chemotherapy or immunotherapy: Target the cancer cells throughout the body but come with broader side effects.

Patient Experience

During the procedure, patients might feel minimal discomfort or pressure when the applicator is placed. Most patients experience a manageable level of discomfort, and pain relief medications can be provided if needed. After the procedure, some soreness or mild skin irritation might occur but is typically short-lived and manageable with over-the-counter medication.