Brachytherapy

Brachytherapy
Arrow points to brachytherapy beads used to treat prostate cancer.
Other names	internal radiotherapy, sealed source radiotherapy, curietherapy, endocurietherapy
ICD-10-PCS	D?1
ICD-9-CM	92.27
MeSH	D001918
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Brachytherapy is a form of radiation therapy where a sealed radiation source is placed inside or next to the area requiring treatment. Brachy is Greek for 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.^[1] 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.^[2][3][4] Brachytherapy can be used alone or in combination with other therapies such as surgery, EBRT and chemotherapy.

Brachytherapy contrasts with unsealed source radiotherapy, in which a therapeutic radionuclide (radioisotope) is injected into the body to chemically localize to the tissue requiring destruction. It also contrasts to External Beam Radiation Therapy (EBRT), in which high-energy x-rays (or occasionally gamma-rays from a radioisotope like cobalt-60) are directed at the tumour from outside the body. Brachytherapy instead involves the precise placement of short-range radiation-sources (radioisotopes, iodine-125 or caesium-131 for instance) directly at the site of the cancerous tumour. These are enclosed in a protective capsule or wire, which allows the ionizing radiation to escape to treat and kill surrounding tissue but prevents the charge of radioisotope from moving or dissolving in body fluids. The capsule may be removed later, or (with some radioisotopes) it may be allowed to remain in place.^{[1]: Ch. 1 [5]}

A feature of brachytherapy is that the irradiation affects only a very localized area around the radiation sources. Exposure to radiation of healthy tissues farther away from the sources is therefore reduced. In addition, if the patient moves or if there is any movement of the tumour within the body during treatment, the radiation sources retain their correct position in relation to the tumour. These characteristics of brachytherapy provide advantages over EBRT – the tumour can be treated with very high doses of localised radiation whilst reducing the probability of unnecessary damage to surrounding healthy tissues.^{[1]: Ch. 1 [5]}

A course of brachytherapy can be completed in less time than other radiotherapy techniques. This can help reduce the chance for surviving cancer-cells to divide and grow in the intervals between each radiotherapy dose.^[5] Patients typically have to make fewer visits to the radiotherapy clinic compared with EBRT, and may receive the treatment as outpatients. This makes treatment accessible and convenient for many patients.^[6][7] These features of brachytherapy mean that most patients are able to tolerate the brachytherapy procedure very well.

The global market for brachytherapy reached US$680 million in 2013, of which the high-dose rate (HDR) and LDR segments accounted for 70%. Microspheres and electronic brachytherapy comprised the remaining 30%.^[8] One analysis predicts that the brachytherapy market may reach over US$2.4 billion in 2030, growing by 8% annually, mainly driven by the microspheres market as well as electronic brachytherapy, which is gaining significant interest worldwide as a user-friendly technology.^[9]