Clinical Applications
Brachytherapy is commonly used to treat cancers of the cervix, prostate, breast, and skin.
Brachytherapy can also be used in the treatment of tumours of the brain, eye, head and neck region (lip, floor of mouth, tongue, nasopharynx and oropharynx), respiratory tract (trachea and bronchi), digestive tract (oesophagus, gall bladder, bile-ducts, rectum, anus), urinary tract (bladder, urethra, penis), female reproductive tract (uterus, vagina, vulva), and soft tissues.
As the radiation sources can be precisely positioned at the tumour treatment site, brachytherapy enables a high dose of radiation to be applied to a small area. Furthermore, because the radiation sources are placed in or next to the target tumour, the sources maintain their position in relation to the tumour when the patient moves or if there is any movement of the tumour within the body. Therefore, the radiation sources remain accurately targeted. This enables clinicians to achieve a high level of dose conformity – i.e. ensuring the whole of the tumour receives an optimal level of radiation. It also reduces the risk of damage to healthy tissue, organs or structures around the tumour, thus enhancing the chance of cure and preservation of organ function.
The use of HDR brachytherapy enables overall treatment times to be reduced compared with EBRT. Patients receiving brachytherapy generally have to make fewer visits for radiotherapy compared with EBRT, and overall radiotherapy treatment plans can be completed in less time. Many brachytherapy procedures are performed on an outpatient basis. This convenience may be particularly relevant for patients who have to work, older patients, or patients who live some distance from treatment centres, to ensure that they have access to radiotherapy treatment and adhere to treatment plans. Shorter treatment times and outpatient procedures can also help improve the efficiency of radiotherapy clinics.
Brachytherapy can be used with the aim of curing the cancer in cases of small or locally advanced tumours, provided the cancer has not metastasized (spread to other parts of the body). In appropriately selected cases, brachytherapy for primary tumours often represents a comparable approach to surgery, achieving the same probability of cure and with similar side effects. However, in locally advanced tumours, surgery may not routinely provide the best chance of cure and is often not technically feasible to perform. In these cases radiotherapy, including brachytherapy, offers the only chance of cure. In more advanced disease stages, brachytherapy can be used as palliative treatment for symptom relief from pain and bleeding.
In cases where the tumour is not easily accessible or is too large to ensure an optimal distribution of irradiation to the treatment area, brachytherapy can be combined with other treatments, such as EBRT and/or surgery. Combination therapy of brachytherapy exclusively with chemotherapy is rare.
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