Brachytherapy in Turkey: An Informational Guide for Patients

What is Brachytherapy?

Brachytherapy is a highly advanced and precise form of radiation therapy where a sealed radioactive source is placed directly inside or next to a cancerous tumor. The word “brachy” is Greek for “short distance,” which perfectly describes this technique. By placing the radiation source at the heart of the cancer, brachytherapy can deliver a very high, targeted dose of radiation to the tumor while minimizing exposure to the surrounding healthy tissues.

This “internal radiation” approach is fundamentally different from the more common external beam radiation therapy (EBRT), where radiation beams are delivered from a machine outside the body. The key advantage of brachytherapy is its precision. Because the radiation only has to travel a very short distance, its dose falls off very rapidly, sparing nearby organs from unnecessary radiation. In Turkish oncology centers, brachytherapy is a critical and often indispensable treatment modality for several types of cancer.

The Specialized Brachytherapy Team

The successful delivery of brachytherapy requires a close partnership between a team of highly skilled specialists. This procedure is both a surgical intervention and a complex radiation planning process.

The team typically includes:

• Radiation Oncologist: A physician with specific expertise in brachytherapy who leads the team. They perform the procedure to place the applicators, determine the target area, and prescribe the radiation dose.
• Surgeon (e.g., Gynecologist, Urologist): Often works alongside the radiation oncologist during the applicator placement procedure.
• Medical Physicist and Dosimetrist: These experts are responsible for the complex physics and calculations of the treatment plan. After the applicators are in place, they use specialized software to create a 3D plan that ensures the radiation dose is delivered precisely to the tumor while avoiding nearby critical organs.
• Anesthesiologist: Manages the patient’s anesthesia and well-being during the surgical placement of the applicators.
• Specialized Nurses and Radiation Therapists: Assist during the procedure and the subsequent radiation delivery, providing care and monitoring the patient.

How Brachytherapy Works: The Two Main Types

Brachytherapy can be categorized based on the rate at which the radiation dose is delivered. The two main types are Low-Dose-Rate (LDR) and High-Dose-Rate (HDR).

1. Low-Dose-Rate (LDR) Brachytherapy

In LDR brachytherapy, small radioactive sources, often called “seeds,” are permanently implanted directly into the tumor tissue. These seeds are about the size of a grain of rice. They emit a low level of radiation over a period of several weeks to months. As the radiation is released, the radioactivity of the seeds gradually decays until they are no longer active. The inactive seeds then remain harmlessly in the body. LDR brachytherapy is most commonly used for the treatment of prostate cancer.

2. High-Dose-Rate (HDR) Brachytherapy

In HDR brachytherapy, a single, highly radioactive source is temporarily placed inside the tumor or the treatment area for a short period of time. The procedure involves first surgically placing a non-radioactive applicator, such as a set of catheters or a specialized device, into the target area. After the applicators are confirmed to be in the correct position, they are connected to a machine called an afterloader, which houses the powerful radioactive source.

The computer-controlled afterloader then guides the source into the applicators for a prescribed amount of time—often just a few minutes. The source delivers a very high dose of radiation with extreme precision before being safely retracted back into the machine. Once the treatment is complete, the applicators are removed. No radioactive material is left in the body. HDR brachytherapy may be delivered in one or several treatment sessions (fractions).

Common Applications of Brachytherapy in Turkish Oncology Centers

Brachytherapy is a standard and vital treatment for several types of cancer.

• Gynecologic Cancers: Brachytherapy is an absolutely essential, curative component of treatment for cervical cancer. For locally advanced cervical cancer, it is used after a course of external beam radiation. HDR brachytherapy delivers the final, decisive “boost” dose directly to the cervix, which is critical for achieving a cure. It is also commonly used to treat endometrial (uterine) cancer after a hysterectomy to reduce the risk of the cancer recurring in the vagina.
• Prostate Cancer: Brachytherapy is a well-established treatment for prostate cancer.
  • LDR brachytherapy (seed implant) can be used as a standalone treatment (monotherapy) with excellent cure rates for men with low-risk, localized disease.
  • HDR brachytherapy can be used as a “boost” in combination with a shorter course of external beam radiation for men with higher-risk prostate cancer.
• Breast Cancer: For some women with early-stage breast cancer who have had a lumpectomy, a form of HDR brachytherapy called Accelerated Partial Breast Irradiation (APBI) may be an option. It involves placing a catheter into the lumpectomy cavity and delivering radiation over a much shorter course (e.g., twice a day for five days) compared to several weeks of traditional external radiation.
• Other Cancers: Brachytherapy is also used to treat cancers of the skin, esophagus, and bile duct, among others.

The Patient Experience: What to Expect During an HDR Procedure

While the specifics vary by cancer type, the general process for an HDR brachytherapy treatment follows a set path.

1. Planning and Consultation: The patient meets with the radiation oncologist to discuss the procedure. A detailed imaging scan (CT or MRI) is often performed to help with pre-planning.
2. The Applicator Placement Procedure: This is a surgical procedure performed in an operating room under anesthesia (either general or regional, like an epidural). The radiation oncologist places the specialized applicators into the target area. For example, for cervical cancer, a tandem and ovoid or ring applicator is placed. For breast cancer, a balloon catheter might be inserted. This is the most complex and time-consuming part of the process.
3. Post-Procedure Imaging and Planning: Immediately after the applicators are placed, the patient has another imaging scan (CT or MRI) with the applicators in place. These images are sent directly to the treatment planning computer. The radiation oncologist and physics team then work quickly to create a precise, individualized 3D radiation plan. This planning process can take a few hours.
4. Treatment Delivery: Once the plan is complete and verified, the patient is taken to the treatment room. The applicators are connected via tubes to the HDR afterloader machine. The team leaves the room, and the machine delivers the treatment as prescribed, which usually takes only 10-20 minutes. The patient is monitored continuously via cameras and an intercom system. The treatment is completely painless.
5. Applicator Removal: After the radiation dose has been delivered, the source is retracted, and the applicators are removed by the doctor or nurse. This is usually done in the treatment room or recovery area and typically does not require anesthesia.
6. Recovery: Depending on the procedure, the patient may be able to go home the same day or may require a short hospital stay for observation.

Frequently Asked Questions

1. What is the main advantage of brachytherapy compared to external beam radiation?
The main advantage is its high degree of precision. By placing the radiation source directly at the tumor, brachytherapy delivers a maximum dose to the cancer cells while the dose falls off very quickly, significantly reducing radiation exposure to nearby healthy organs. This can lead to fewer side effects.

2. Is brachytherapy a type of surgery?
The brachytherapy treatment itself is a two-step process. The placement of the applicators (catheters, needles, or devices) is a surgical procedure that is performed in an operating room under anesthesia. The subsequent delivery of the radiation through those applicators is a non-surgical radiotherapy procedure.

3. Is the radiation source left in my body?
This depends on the type of brachytherapy. In High-Dose-Rate (HDR) brachytherapy, the powerful source is only placed inside the applicators temporarily (for a few minutes) and is then completely removed. No radioactivity is left in your body. In Low-Dose-Rate (LDR) brachytherapy, such as prostate seed implants, the small, low-energy radioactive seeds are left in the body permanently, but their radioactivity decays over a few months until it is gone.

4. Will I be radioactive after brachytherapy? Am I a danger to my family?
After HDR brachytherapy, you are not radioactive at all and can safely be around other people, including children and pregnant women. After an LDR prostate seed implant, there is a very low level of radiation emitted for a short period. Your doctor will give you simple, specific precautions to follow for a limited time, but the overall risk to others is extremely minimal.

5. Is the procedure painful?
The placement of the brachytherapy applicators is done under anesthesia, so you will not feel pain during the procedure itself. You may experience some discomfort, soreness, or cramping in the treatment area for a few days after the procedure, which can be managed with medication. The delivery of the radiation is completely painless.

6. For which cancers is brachytherapy most commonly used in Turkey?
Brachytherapy is a standard and essential treatment for gynecologic cancers, particularly cervical and endometrial cancer. It is also a very common and highly effective treatment option for localized prostate cancer. Its use in other areas, such as breast and skin cancer, is also well-established in specialized centers.

7. How long does a brachytherapy treatment take?
The entire process can take several hours, but the actual time the radiation is being delivered is very short. The applicator placement may take one to two hours. The subsequent treatment planning can take another two to three hours. The final HDR radiation delivery itself often lasts for only 10 to 20 minutes.