HDR Brachytherapy: Specialists and Information

HDR brachytherapy is a form of internal radiation therapy. In this procedure, the doctor implants the radiation source in close proximity to the tumor or directly into the tumor tissue.

Depending on the findings, this form of internal radiation therapy can be combined with

• surgery,
• chemotherapy, and
• external radiation therapy

.

The prefix “brachy-” in the medical term “brachytherapy” means “short or close.” In this form of therapy, HDR stands for “High Dose Rate” and refers to the high dose administered over a very short period of time. This distinguishes HDR brachytherapy from LDR brachytherapy (“low dose rate”), which involves a low dose over a longer period of time.

The longer-term, low-dose LDR treatment is suitable for smaller, slow-growing tumors. In contrast, the time-limited, high-dose HDR brachytherapy is suitable only for the internal irradiation of larger, fast-growing tumors.

The doctor adjusts the strength of the required dose based on the

• size,
• nature, and
• prognosis

of the cancer tumor.

HDR brachytherapy is suitable for treating tumors that are clearly demarcated locally. In addition, the tumor must be easily accessible for implantation. Indications for brachytherapy include, among others:

• Uterine cancer
• Cervical cancer
• Breast cancer
• Oral and oropharyngeal tumors
• Lip cancer
• Prostate cancer
• Esophageal cancer
• Liver cancer

Doctors often combine this highly individualized method of internal tumor radiation therapy with external radiation therapy (percutaneous radiation therapy). In this case, HDR brachytherapy is also used as a booster. It is then applied to achieve dose saturation following conventional external radiation therapy (for example, in cases of breast cancer or prostate cancer). HDR brachytherapy as a dose-completion booster treatment can be gentler on the patient and less taxing on their health than continuing external radiation therapy without interruption.

For HDR brachytherapy, an access point for the radiation source must first be created. This is done by implanting fine hollow tubes or hollow needles, usually under local anesthesia. The treatment can often be performed on an outpatient basis without a hospital stay, and the patient can return home after a few hours.

Depending on the tumor’s location or on the recommendation of the treating physician, some patients opt for gentle spinal anesthesia or—rarely—general anesthesia. The radiation oncologist then develops a radiation treatment plan in collaboration with medical physics specialists. Finally, the radioactive material iridium-192 is placed directly in or near the tumor tissue using medical technology. This is known as the “afterloading” procedure.

The actual HDR brachytherapy—that is, the duration of radiation exposure—is very brief and lasts only a few minutes. The treatment is not painful for the patient.

Potential damage to adjacent tissue and skin can be reliably prevented.

The major advantage of this treatment is the very high, concentrated radiation dose combined with a very short range. As a result, the intense radiation affects only the tumor tissue, while healthy tissue is better spared. A prolonged hospital stay is usually unnecessary.