High Dose Rate (HDR) Brachytherapy

High Dose Rate (HDR) internal radiation therapy, also known as brachytherapy, utilizes radioactive material inserted into applicators within body cavities or tissues in close proximity to the tumor, allowing for a high dose of radiation to be delivered precisely to the tumor. HDR brachytherapy is a temporary implant conducted in an outpatient setting and minimizes treatment time. A CT scan is performed while the implant is inserted to verify the exact catheter or applicator placement, resulting in a radiation dose with one-millimeter accuracy that significantly spares radiation exposure to surrounding healthy tissue and critical organs. Internal radiation therapy delivers a higher dose of radiation directly to the cancerous area than external radiation treatments. Internal radiation therapy may be utilized to treat breast, prostate, skin and gynecological cancers. 

What is HDR Brachytherapy?

• High Dose Rate (HDR) brachytherapy is a radiation treatment that allows physicians to deliver precise radiation treatment directly to a patient’s cancerous tumors utilizing catheters, thin, flexible needles or applicators inserted into a body cavity or directly into the tissue.
• It is a computer-controlled delivery system that optimizes dose distribution to the target.
• HDR brachytherapy is frequently used in the treatment of breast, cervical and uterine cancers, intraluminal treatment of certain lung cancers causing bronchial obstructions and obstructing esophageal cancers.  It has also recently been shown to be effective for treatment of early-stage prostate cancer.

Why is HDR used?

• HDR brachytherapy delivers radiation with extreme precision.  Advanced imaging allows catheters to be precisely located so the intended dose can be delivered to a position with 1-millimeter accuracy.
• HDR brachytherapy can often be delivered on an outpatient basis and no radioactive material is left in the body.
• Treatment times are typically several minutes in duration instead of several days that are required for low dose rate brachytherapy.
• Because radiation is delivered directly to the tumor, a higher dose is used, yet exposure to surrounding healthy tissue is limited.  HDR brachytherapy results in less than a two percent chance of permanent damage to any of the adjacent normal tissue.

How is HDR Brachytherapy treatment planned and delivered?

• The physician determines whether HDR brachytherapy will be administered through a thin catheter, a flexible needle placed through the skin, or through applicators that are inserted into a body cavity such as the breast, lung, GYN, or esophagus.
• If deemed a candidate, breast patients will have a SAVI ™device inserted by a surgeon prior to starting their HDR treatments. For GYN patients, a smit sleeve is surgically placed prior to starting HDR.
• Patients are treated as an outpatient, with sedation, if needed..
• When catheters are used, treatment will be delivered twice a day, six hours apart for five days for breast patients.  
• Following a computed tomography (CT) scan of the treatment area, a three-dimensional (3D) reconstruction of the target organ/cancer and adjacent tissue is made to confirm placement of the implant device and plan the delivery sequence of the radioactive source for ideal dose distribution.
• The HDR brachytherapy equipment is programmed with the patient’s specific treatment and connected to the implant device with transfer tubes.
• Each treatment will last between 10-15 minutes, and during the treatment, the physician and clinical staff continually monitor and communicate with the patient directly outside the treatment room.
• When treatment is complete, the radioactive source is retracted back into the HDR brachytherapy machine, and the transfer tubes are disconnected.  For intracavitary implants, treatments will be given two times per week, are removed, and the patient is allowed to return home after the procedure.  Patients having sedation will need a driver to take them home each treatment.