What is brachytherapy and how does it work?

Radiotherapy is an important way to treat cancer. About 4 out of 10 people with cancer have some type of radiotherapy as part of their treatment. It works by destroying the cancer cells by targeting them with radiation, stopping them dividing and growing.

. There are two basic types of radiotherapy:

1. External beam radiotherapy (EBRT)
2. Brachytherapy - also sometimes known as internal radiotherapy

Brachytherapy works by targeting the cancerous tumor from inside the body. The source of radiation is placed directly inside or next to the tumor. This approach reduces the risk of damage to healthy tissue and organs that are close to the tumor.

Brachytherapy is different from external beam radiotherapy, which delivers radiation from outside the body. This means that the radiation has to travel through healthy tissue to reach the tumor - so more healthy tissues and organs could be exposed.

In brachytherapy, the method of delivering the radiation directly to the tumor depends on a number of things, including where the cancer is located.

Brachytherapy can be either:

. Permanent - tiny radioactive seeds, the size of a grain of rice, are placed into the tumor. The seeds give off low levels of radiation for a few months, killing the cancer cells. This is commonly used in prostate cancer
. Temporary - the source of radiation is delivered to the tumor, and then removed after a few minutes

Brachytherapy has been shown to be highly effective in treating many types of cancer. Examples are prostate, breast, cervix and many more. Brachytherapy is particularly effective for small, localized tumors. It is a commonly used and proven method of treatment which has been in use for over a 100 years. In more recent years, new technology has continually improved the treatment to make it even more accurate and effective.

Doctors plan and deliver brachytherapy by using computer-based technology to decide how and where the radiation should be delivered. A special device then ensures that the radiation is delivered precisely and accurately to the target tumor.

What are the benefits of brachytherapy?

There are a number of potential benefits of brachytherapy compared to other options such as external beam radiotherapy or surgery.

The benefits of brachytherapy are:

. Very effective in treating cancer as radiation is delivered in a precise way
. Side effects are minimized due to the targeted nature of brachytherapy
. Minimally invasive technique
. Short treatment times (from 1 to 5 days)
. Short recovery times (typically 2 to 5 days) - people can usually return to everyday activities within a couple of days
. Less frequent visits to the hospital and overnight stays than with other options

Brachytherapy can be used to treat your cancer on its own or in combination with other treatment methods, like surgery or external beam radiotherapy, depending on what is needed for your treatment and is best for you.

These benefits of brachytherapy can get you back to your everyday life sooner with minimal disruption.

What else should I know about brachytherapy ?

As for all cancer treatments, you may experience side effects after your treatment. Different people respond in different ways. The type of side effects varies on a number of things, such as the type of cancer being treated, what stage it is and what other health problems you may have.

Some patients may experience side effects soon after the treatment procedure. These can include bruising, swelling, discharge or discomfort in the area which has been treated. Or you may feel dizzy or tired. These can be treated with medication and will go away after a short time. Later side effects may occur in a small number of patients and are generally an effect of the radiation itself. Studies have shown that patients in general experience fewer side effects after brachytherapy than with other treatments.

Some people are concerned about possible effects of their treatment on their family. When temporary brachytherapy is used, no radioactive sources remain in the body after treatment. So, there is no radiation risk to friends or family. With seed implants, e.g. for prostate cancer, only the seeds are radioactive - not the patient. The radiation levels in the seeds are very low, and go away completely over time.

When discussing treatment options, it's always important to ask your doctor about what side effects may occur with the different available treatments.

Can patients travel while undergo Chemotherapy? And if so, what Precautions should be taken ?

• In most cases, Yes as long as patients are travelling to an area where good medical care can be received urgently if necessary. However it is recommended that patients do not travel during their first cycle of Chemotherapy, because at that point the side effects and tolerance of the therapy are unknown.
• It is not necessary to wear a facemask doing air travel.
• Frequently hand washing in essential
• Wear loose fitting, non constrictive clothing.
• Getting every 30-60 minutes and walk up and down the aisle of the plane
• Drink plenty of fluids to avoid dehydration.
• The National Lymphoedema Network (NLN) recommends that:
• Individuals with a confirmed diagnosis of lymphoedema should use some form of compressive therapy while travelling by air

If a patients calls with a fever during Chemotherapy, how should she be advised ?

a) If a patient has fever during Chemotherapy period the doctors addresses the problem urgently with a provision for emergency admission in the hospital.

b) If a patient stay further away from the hospital, it is better to contact a primary general physician of her locality and discuss with the concerned oncologist of her mode of action.

c) Evaluation of a febrile patient (>100.5*F) during Chemotherapy includes the flowing

Blood Work- Complete blood Counts, comprehensive biochemical panel, bold culture tests

Urine culture / culture of any other obvious source that is round, central catheter site.

Chest X-ray or other imaging study is indicated

d) Treatment depend on the laboratory values and chemical evaluation

My patient has completed her treatment with Chemotherapy. What type of evaluation or scanning is involved

The Nation comprehensive Cancer Network (NCCN) recommends the following guidelines

a)Interval history and physical emanation every 3 to 6month for 5 years, then every 12 monthly.

b) Mammogram every 12 months

c) No specific blood work or radiological investigation is needed unless otherwise recommended.

d) Women on tamoxifen , annual gynecological assessment every 12 month if the uterus in present

e) Women  on an aromatase inhibitors or who experience ovarian failure secondary to treatment: monitoring of bone health is important