One of the methods of treating malignant tumors is brachytherapy. It is often used to treat prostate cancer. For a short period of time, the technique has taken a leading position, to this day is gaining popularity.
The concept of
is an innovative technology of radiological irradiation.
The effectiveness of the method lies in the possibility of irradiating only a small area with high doses of gamma rays.
The method is applied once, does not require systematic repetition, which significantly reduces the inconvenience to the patient. It is used both as an independent method for treating cancer, and for stopping the growth of education.
In palliative medicine is used to relieve the pain syndrome.
Species
There are two main types:
- constant,
- temporary.
In the first case, the doctor acts in small doses of the radioactive component. The technique is effective at the first stages of cancer.
The second type involves the introduction of high doses of radiation. A good effect is achieved in the third stage of the disease.
There is a difference between brachytherapy and the method of administration. The radiating element is injected directly by the surgeon manually or automatically, using special equipment. For this, isotopes of cobalt, iodine, cesium, palladium and others can be used.they differ in their half-life, power.
Depending on the affected area, the procedure is:
- Intracavitary, intraluminal. The source of radioactive radiation is placed next to the tumor or inside it. The method is effective for the treatment of cancer of the esophagus, rectum, gynecological organs, bronchi.
- Interstitial. The implant is inserted into the tumor. Used to treat the prostate.
- Vascular. The source is inserted into the vessel walls.
- Superficial. Application is done on the skin.
- Ophthalmic. It is fixed on the sclera under the tumor.
Indications
Brachytherapy to men and women is prescribed depending on the location of the tumor.
The most commonly prescribed for men with prostate cancer is a good or moderate degree of tumor aggressiveness, without affecting the seminal vesicles, without signs of impaired urination.
In this case, the PSA should not be more than 15-20 ng / ml. If transurethral resection of the prostate was performed earlier, the decision on the appropriateness of the method is taken on individual indications.
The procedure is effective for the treatment of:
- of the head and neck region,
- of the bladder,
- of the cervix,
- of the vulva,
- of the mammary glands,
- of the lung,
- of the rectum.
Contraindications
The main contraindication is the exit of the tumor beyond the limits of one organ, the appearance of metastases in the lymphatic and any other system.
No method is prescribed if survival after surgery is projected to be less than five years.
If there are abnormalities in the process of urination, there is the presence of residual urine, inflammatory processes in the pelvic organs, the procedure is postponed until complete cure.
Since brachytherapy is performed under general anesthesia, it can not be administered to people with contraindications to it.
Low-dose brachytherapy for prostate cancer
The treatment procedure is to administer radioactive grains in the prostate tissue at a dosage of about 140 Gy. As the active substance is more often iodine-125, but sometimes use palladium-103.
The plus is the local radiation direction, so healthy tissues remain intact. After the completion of the course, the grains lose their effect.
The patient is discharged on the same day or the next.
High-dose brachytherapy for prostate cancer
In contrast to the previous method, high-dose therapy is used to affect cancer cells that are distributed outside the capsule of the prostate gland. It is suitable for all types of cancer, since the second dose of radiation is several tens of thousands of times more powerful.
Brachytherapy is especially often used to treat high-risk cancer. In some cases, it is combined with external radiation therapy.
First, the doctor injects into the gland an irradiation source with radioactive substances, after reaching the required dose, it is extracted. Iridium-192 or cesium-137 is most often used. This method is carried out in several sessions for 5-15 minutes with a break of several days.
In case of oncology of the cervix
If treatment is carried out with small doses of radiation, then women undergo in-patient treatment.the cylinder is placed in the vagina for several days. This allows you to evenly destroy cancer cells. During this period, women are forbidden to get up, exercise.
High-dose irradiation is performed in a hospital, consists of several sessions. The duration is not more than a few minutes. The method does not require hospitalization, and the course itself takes about a month.
Brachytherapy of the cervix adversely affects the condition of the pelvic bones, so for several years you need to be especially careful not to encounter a hip fracture. Often, the consequences include disruption of the hormonal background, premature onset of menopause.
Breast cancer
It is prescribed for those who have suffered a segmental resection of the breast or its amputation.is also prescribed as a palliative treatment in the late stages of the disease.
The technique helps to reduce the size of the tumor, to enhance the effect of remote irradiation.
It is carried out using balloon catheters, which are connected to the radiation supply device twice a day. The accuracy of the impact is provided by a special computer program. The catheter is removed after the end of radiation therapy.
Rectum
Brachytherapy is performed before surgery, after surgery, for the treatment of metastases.
Oncologists often prescribe internal and external exposure. The method of treatment with low doses is recommended for those who have a tumor less than 3 cm.
The method is effective even when there are contraindications to surgery. The procedure is performed out-patient, if it is a contact form.
It is compulsory for the patient to prepare in advance for the procedure. It is important to follow a diet with limited intake of dietary fiber. The applicator is inserted into the rectum by means of a special tube. The latter provides the necessary dose of radiation. The procedure itself lasts about a minute. The next session takes place after 14 days.
After treatment, observation is required, since anus stenosis, the formation of a hole in the gut or bladder, the appearance of a fistula is possible.
How is the procedure performed?
Throughout the course the patient is under the supervision of anesthesiologists, surgeons, radiologists, oncologists. For a month, an MRI scan is performed to compile an accurate picture.
The resulting images are used for a computer program that creates a 3D model for all the necessary organs. Calculates the location of the capsules, the dose of the substance.
The second stage is implantation. Depending on the affected organ, local or general anesthesia is prescribed. Implantation is carried out under the control of ultrasound, MRI, CT.The entire process is visible through the computer screen.
Further manipulations depend on the method used. For example, in the treatment of the prostate with low doses, the implant is retained for several months. Periodically repeated research aimed at studying the location of radiation sources.
High-frequency brachytherapy uses needles that contain isotopes. The procedure lasts about 10 minutes, after which the needles are removed until the next session.
Side effects of
They are temporary or permanent. Among popular:
- Violation of urination. Occurs in every third person in the treatment of genital cancers.
- Erectile dysfunction or impotence. The risk of occurrence depends on the age of the man.
- Rectal problems. Ulcers often appear, bleeding begins.
- Fatigue. Patients often find that even a small load leads to severe fatigue.
- Nausea and diarrhea. Often occur in the treatment of colon cancer.
- Inflammation of the skin. Affects areas in close proximity to the treated area.
Treatment leads to early menopause, difficulty in erection, loss of fertility, dryness and narrowing of the vagina.
Restrictions on
There are practically no limits to life, as the patient receives only internal irradiation.
However, you can not perform physical activities, take the hands of children. Especially if the treatment was carried out with iodine-125, since during half-life, it is 60 days.
Some doctors do not recommend traveling by car, horses, bicycle. In the first months it is recommended to limit contact with pregnant women so as not to expose them to radiation.
Reviews
The method is quite new, so many people rely on feedback when deciding. For many in the treatment of the prostate gland, an insignificant number of complications, a small rehabilitation period, a small stay in the oncology center is important. The result is the same as in surgical treatment.
Women suffering from cervical cancer note that the procedure is a little uncomfortable, but does not cause severe pain. The only inconvenience is bed rest. A few months later, it is possible to completely return to normal life.
Treatment prices in Moscow
The method is effectively used in Europe. There its cost is about 15,000 dollars. In Russia, brachytherapy is on the list of high-tech medical care, so you can get it free of charge for quotas.
Video shows what brachytherapy is and how it is done: