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Brachytherapy

Brachytherapy is a form of radiation therapy where a sealed radiation source is placed inside or next to the area requiring treatment. The word "brachytherapy" comes from the Greek word βραχύς, brachys, meaning "short-distance" or "short". Brachytherapy is commonly used as an effective treatment for cervical, prostate, breast, esophageal and skin cancer and can also be used to treat tumours in many other body sites. Treatment results have demonstrated that the cancer-cure rates of brachytherapy are either comparable to surgery and external beam radiotherapy (EBRT) or are improved when used in combination with these techniques. Brachytherapy can be used alone such as in early prostate cancer or in combination with other therapies such as surgery, EBRT and chemotherapy such as in advanced cervical cancer

Medical uses
Brachytherapy is commonly used to treat cancers of the cervix, prostate, breast, and skin. urinary tract (bladder, urethra, penis), female reproductive tract (uterus, vagina, vulva), and soft tissues. Patients receiving brachytherapy generally have to make fewer visits for radiotherapy compared with EBRT, and overall radiotherapy treatment plans can be completed in less time. Many brachytherapy procedures are performed on an outpatient basis. This convenience may be particularly relevant for patients who have to work, older patients, or patients who live some distance from treatment centres, to ensure that they have access to radiotherapy treatment and adhere to treatment plans. Shorter treatment times and outpatient procedures can also help improve the efficiency of radiotherapy clinics. Brachytherapy can be used with the aim of curing the cancer in cases of small or locally advanced tumours, provided the cancer has not metastasized (spread to other parts of the body). In appropriately selected cases, brachytherapy for primary tumours often represents a comparable approach to surgery, achieving the same probability of cure and with similar side effects. However, in locally advanced tumours, surgery may not routinely provide the best chance of cure and is often not technically feasible to perform. In these cases radiotherapy, including brachytherapy, offers the only chance of cure. In more advanced disease stages, brachytherapy can be used as palliative treatment for symptom relief from pain and bleeding. In cases where the tumour is not easily accessible or is too large to ensure an optimal distribution of irradiation to the treatment area, brachytherapy can be combined with other treatments, such as EBRT and/or surgery. Cervical cancer Brachytherapy is commonly used in the treatment of early or locally confined cervical cancer and is a standard of care in many countries. Cervical cancer can be treated with either LDR, PDR or HDR brachytherapy. Used in combination with EBRT, brachytherapy can provide better outcomes than EBRT alone. The chances of staying free of disease (disease-free survival) and of staying alive (overall survival) are similar for LDR, PDR and HDR treatments. However, a key advantage of HDR treatment is that each dose can be delivered on an outpatient basis with a short administration time Prostate cancer Brachytherapy to treat prostate cancer can be given either as permanent LDR seed implantation or as temporary HDR brachytherapy. Permanent seed implantation is suitable for patients with a localised tumour and good prognosis and has been shown to be a highly effective treatment to prevent the cancer from returning. The survival rate is similar to that found with EBRT or surgery (radical prostatectomy), but with fewer side effects such as impotence and incontinence. The procedure can be completed quickly and patients are usually able to go home on the same day of treatment and return to normal activities after one to two days. Permanent seed implantation is often a less invasive treatment option compared to the surgical removal of the prostate. HDR brachytherapy as a boost for prostate cancer also means that the EBRT course can be shorter than when EBRT is used alone. Brachytherapy can be used after surgery, before chemotherapy or palliatively in the case of advanced disease. Brachytherapy to treat breast cancer is usually performed with HDR temporary brachytherapy. Post surgery, breast brachytherapy can be used as a "boost" following whole breast irradiation (WBI) using EBRT. More recently, brachytherapy alone is used to deliver APBI (accelerated partial breast irradiation), involving delivery of radiation to only the immediate region surrounding the original tumour. The main benefit of breast brachytherapy compared to whole breast irradiation is that a high dose of radiation can be precisely applied to the tumour while sparing radiation to healthy breast tissues and underlying structures such as the ribs and lungs. An applicator is placed in the cavity left after tumour removal and a mobile electronic device generates radiation (either x-rays) and delivers it via the applicator. Radiation is delivered all at once and the applicator removed before closing the incision. Intracavitary breast brachytherapy Intracavitary breast brachytherapy (also known as "balloon brachytherapy") involves the placement of a single catheter into the breast cavity left after the removal of the tumour (lumpectomy). There are also devices that combine the features of interstitial and intracavitary breast brachytherapy (e.g. SAVI). These devices use multiple catheters but are inserted through a single-entry point in the breast. Studies suggest the use of multiple catheters enables physicians to target the radiation more precisely. Permanent breast seed implantation Permanent breast seed implantation (PBSI) implants many radioactive "seeds" (small pellets) into the breast in the area surrounding the site of the tumour, similar to permanent seed prostate brachytherapy. The seeds are implanted in a single 1–2 hour procedure and deliver radiation over the following months as the radioactive material inside them decays. Risk of radiation from the implants to others (e.g. partner/spouse) has been studied and found to be safe. In a clinical study, GammaTile Therapy improved local tumor control compared to previous same-site treatments without an increased risk of side effects. Esophageal cancer For esophageal cancer radiation treatment, brachytherapy is one option for effective treatment, involves definitive radiotherapy (boost) or palliative treatments. Definitive radiotherapy (boost) can deliver the dose precisely and palliative treatments can be given to relieve dysphagia. The large diameter applicators or balloon type catheter are used with the afterloader to expand the esophagus and facilitate the delivery of radiation dose to tumor with sparing of nearby normal tissue. Brachytherapy followed EBRT or surgery have been shown to improve the survival rate and local recurrent rate than EBRT or surgery only for esophageal cancer patients. Brachytherapy for skin cancer provides good cosmetic results and clinical efficacy; studies with up to five years follow-up have shown that brachytherapy is highly effective in terms of local control, and is comparable to EBRT. Treatment times are typically short, providing convenience for patients. It has been suggested that brachytherapy may become a standard of treatment for skin cancer in the near future. In treating In-stent restenosis (ISR) Drug Eluting stents (DES) have been found to be superior to Intracoronary Brachytherapy (ICBT).