Brachytherapy is a method of delivering radiation to tumors by placing radioactive sources in close proximity to the tumor (“intracavitary” brachytherapy) or within the tumor itself (“interstitial brachytherapy).

Derived from the Ancient Greek word brachios meaning “short”, brachytherapy is sometimes referred to as “internal” radiation therapy or an “implant”.

Since a radiation source is placed close to or directly within the tumor, higher radiation doses can be typically delivered than with external beam radiotherapy.  Moreover, rapid dose falloff around the sources means that less radiation is delivered to surrounding normal tissues.

How is Brachytherapy Performed?                                                                       

Brachytherapy is most commonly performed with either high-dose-rate (HDR) or low-dose-rate (LDR) techniques.  LDR approaches predominantly for much of the last century and have been used in a wide variety of tumor sites, notably cervical and uterine cancers.

In gynecology patients undergoing LDR brachytherapy, an applicator is placed within the cervix/uterus with the patient under general anesthesia in the Operating Room.  Radioactive sources, typically Cesium-137, are later inserted into the applicator (“after-loaded”) once the patient is transferred to a shielded hospital room. 

LDR patients are kept at strict bedrest for 1-3 days, with the procedure typically repeated in 1-2 weeks depending on the dose required and site treated.

Fletcher-Suit-Declos Applicator LDR Brachytherapy, Cervical Cancer

High Dose Rate (HDR) Brachytherapy                                         

More recently, HDR have all but replaced LDR techniques in most tumor sites.  Unlike LDR, HDR is an outpatient procedure avoiding the need for general anesthesia and a prolonged hospital stay at bedrest.  This is particularly appealing in the elderly and in patients with multiple medical problems.

HDR picture

HDR Brachytherapy uses high activity Iridium-192 sources, allowing treatment to be delivered within minutes as opposed to several days.  HDR is performed in a special HDR Suite within the Department of Radiation Oncology. Between treatments, the Iridium source is stored in a shielded device and is delivered under computer control.

HDR Machine

An important benefit to HDR brachytherapy is that the source position can be precisely adjusted, allowing the Radiation Oncologist to create customized dose distributions based on the individual patient’s anatomy and tumor.

HDR Brachytherapy is the preferred method of Brachytherapy at UCSD and is used in a wide variety of disease sites including cervical cancer, endometrial (uterine) cancer, and breast cancer. State-of-the-art HDR afterloading and CT-based computerized Treatment Planning systems are used to deliver HDR brachytherapy. 

Other Tumor Sites                                                                                       

Brachytherapy is also used in the treatment of brain tumors (Gliasite), ocular tumors (eye plaques) and for palliation in obstructive lung and head/neck tumors (endobronchial brachytherapy).

Interested in learning more about Brachytherapy?
Check out the American Brachytherapy Society (ABS) website
It contains additional patient-oriented information, helpful links, and other patient resources

Brachytherapy Publications by UCSD Faculty                                        

Boyd J, Wilson L, Spanos W, Yashar CM.  Hi-Art Tomotherapy megavoltage CT-based cumulative DVH and isodose curve plans for LDR brachytherapy of cervical cancer. Brachytherapy 2006;5:101

Aydogan B, Wang S, Smith B, Mundt AJ, Roeske JC.  IMRT as an alternative to intracavitary HDR vaginal brachytherapy in patients with early stage endometrial cancer. Int J Radiat Oncol Biol Phys 2006;65:266

Xia D, Roeske JC, Yu L, Pelizzari CA, Mundt AJ, Pan X. A hybrid approach to reducing CT metal artifacts in intracavitary brachytherapy/ Brachytherapy 2005;4:18-23

Wilson D, Hughes S, Yashar CM. Tomotherapy megavoltage imaging for gynecological brachytherapy treatment planning and IMRT integration. Med Phys 2005;32:1951

Roeske JC, Lund C, Pelizzari CA, Pan X, Mundt AJ. Reduction of CT metal artifacts due to the Fletcher-Suit applicator in gynecology patients receiving intracavitary brachytherapy. Brachytherapy 2003;2:207-214

Mundt AJ, Roeske JC. Can intensity modulated radiation therapy replace brachytherapy in the treatment of patients with cervical cancer? Brachytherapy 2002;1:192-3

Wollschlaeger K, Connell PP, Waggoner S, Rotmensch  J, Mundt AJ.  Acute problems during LDR intracavitary brachytherapy for cervical carcinoma. Gynecol Oncol 2000;76:67-72

Lapeyre M, Hoffstetter S, Peiffert D, Maire F, Dolivet G, Toussaint B, Mundt AJ, et al. Postoperative brachytherapy alone for T1-2 N0 squamous cell carcinomas of the oral tongue and floor of mouth with close or positive margins.  Int J Radiat Oncol Biol Phys 2000;48:37-42

Rotmensch J, Connell PP, Yamada D, Waggoner SE, Mundt AJ. One versus two intracavitary brachytherapy applications in early stage cervical cancer patients undergoing definitive radiation therapy. Gynecol Oncol 2000;78:32-38

Mundt, AJ, Waggoner, S., et al. Preoperative intracavitary brachytherapy in early stage cervical carcinoma. Am J Clin Oncol 1999;22:737-7

Sandhu APS, Robertson AG, Souter DS et al. Interstitial Ir-192 implantation for recurrent and/or locally advanced head/neck cancer. Clin Oncol 1999;11:371-378

Sandhu APS, Symonds RP, Robertson AG et al. Interstitial Ir-192 combined with external RT in anal cancer: Ten years experience. Int J Radiat Oncol Biol Phys 1998;40:575-581

Saw CB, Korb LJ, Pawlicki T et al. Dose volume assessment of high dose rate 192Ir endobronchial implants. Int J Radiat Oncol Biol Phys 1996;34:917-22

Gupta BD, Singh DP, Sandhu APS, et al. Role of Iridium-192 isotope in the management of inoperable chest wall recurrence of carcinoma breast: A feasibility study. J Clin Radiother Oncol 1993;8:55-58