Name of the Procedure:

Remote Afterloading High Dose Rate Radionuclide Brachytherapy (HDR Brachytherapy) - Interstitial or Intracavitary, 1 Channel

Summary

Remote afterloading high dose rate (HDR) brachytherapy is a type of internal radiation therapy where a radioactive source is placed inside or near the tumor. This procedure uses a single delivery channel to precisely target cancerous tissues, minimizing exposure to surrounding healthy tissues.

Purpose

HDR brachytherapy aims to treat cancers by delivering high doses of radiation directly to the tumor site. It is used to:

• Shrink or eliminate tumors.
• Minimize radiation exposure to surrounding healthy tissues.
• Improve the chances of tumor control and patient survival.

Indications

HDR brachytherapy is indicated for patients with specific types of cancers, including but not limited to:

• Prostate cancer
• Cervical cancer
• Endometrial cancer
• Breast cancer
• Certain head and neck cancers

Patients appropriate for this procedure typically have localized tumors that are accessible via interstitial (within the tissue) or intracavitary (within a body cavity) routes.

Preparation

Patients may need to:

• Fast for several hours before the procedure.
• Follow specific medication instructions provided by their healthcare team.
• Undergo pre-procedure diagnostic tests such as imaging scans (CT, MRI) and physical exams to determine the precise tumor location and size.

Procedure Description

1. The patient is positioned in a way that allows optimal access to the tumor site.
2. Local anesthesia or sedation may be administered to ensure comfort.
3. A catheter or applicator is inserted into or adjacent to the tumor, guided by imaging techniques.
4. The remote afterloading device delivers the radioactive source through the catheter or applicator into the tumor.
5. Radiation is emitted in a controlled manner, targeting the tumor while sparing healthy tissues.
6. The radioactive source is removed after the prescribed dose is delivered, and the applicator is withdrawn.

Duration

The procedure typically takes about 1 to 2 hours, including preparation and recovery time.

Setting

HDR brachytherapy is usually performed in a hospital's radiation oncology department or a specialized outpatient clinic.

Personnel

• Radiation oncologist
• Medical physicist
• Radiation therapist
• Oncology nurse

Risks and Complications

• Localized pain or discomfort at the insertion site.
• Bleeding or infection.
• Temporary swelling or bruising.
• Rarely, damage to surrounding organs and tissues.

Benefits

• Precise targeting of the tumor with high-dose radiation.
• Minimal exposure to healthy tissues.
• Potential for effective tumor control and improved survival rates.
• Typically fewer sessions needed compared to external beam radiation therapy.

Recovery

• Patients may experience some mild pain or discomfort, which can be managed with medications.
• Most patients can go home the same day or the following day.
• Follow-up appointments will be scheduled to monitor response to treatment and manage any side effects.
• Patients may have activity or dietary restrictions as advised by their healthcare provider.

Alternatives

• External beam radiation therapy (EBRT)

  • Pros: Non-invasive, suitable for tumors not accessible by brachytherapy.
  • Cons: Longer treatment duration, higher exposure to surrounding healthy tissue.

• Surgery

  • Pros: Potentially curative by physically removing the tumor.
  • Cons: Invasive, associated with longer recovery time and higher risks.

• Chemotherapy

  • Pros: Effective for systemic cancer spread.
  • Cons: Systemic side effects, less targeted than brachytherapy.

Patient Experience

• During the procedure, patients may feel pressure or discomfort at the insertion site.
• After the procedure, mild pain or soreness is common but manageable with medications.
• Patients are encouraged to communicate any discomfort or concerns to their healthcare team to ensure prompt management.