Brachytherapy

Radiation Oncology Victoria brachytherapy

Brachytherapy is a type of radiation treatment for cancer where a small radioactive source is introduced directly into the tumour or organ. There are 2 main types of brachytherapy for prostate cancer: High Dose Rate (HDR), where a single radioactive seed is temporarily implanted into the prostate, and Low Dose Rate (LDR), where radioactive seeds are permanently implanted. The type of brachytherapy treatment recommended by your Radiation Oncologist will depend upon what is appropriate for your care.

At the time of your initial consultation your Radiation Oncologist will explain the intended brachytherapy process to you, and answer any questions you may have.

What to expect - Prostate High-Dose Rate (HDR) Brachytherapy

Step 1: Initial consultation

An examination may be required at this appointment, along with review of any relevant X-rays, scan and test results, so please bring them along. Your Radiation Oncologist will discuss treatment options specific to your needs and any potential short or long term side effects. The brachytherapy process will be explained to you in detail, and you will have the opportunity to ask questions. Once you make the decision to proceed with HDR brachytherapy, your doctor will contact your urologist and the brachytherapy team. A brachytherapy team member will be in touch to coordinate admission to Ringwood Private Hospital and other treatment appointments. You will receive a letter with all appointment details and preparation you need to undertake in the lead up to your procedure.

Step 2: Treatment setup and implant

HDR brachytherapy is a surgical procedure that requires the co-ordinated effort of a multi-disciplinary team: Urologist, Radiation Oncologist, anaesthetist, nurse, radiation therapist and medical physicist.

You will be admitted to hospital early in the morning, approximately 7.00 a.m. Once in theatre, you will be given a spinal anaesthetic for pain management. A urinary catheter is inserted for bladder management. Your Radiation Oncologist will carry out the surgical procedure, which involves the insertion of plastic catheters (needles) into the prostate through the perineum (area between anus and scrotum) guided by transrectal ultrasound and a calibrated reference template (Fig. 1). The number of catheters required varies from 12 - 18, depending upon the size of your prostate. The template and needles will remain in your perineum area until the treatment is finished. The Urologist will also perform a cystoscopy to confirm the position of the catheters. This will involve inserting a camera into your urethra.

After the procedure you will spend time in the recovery unit before heading over to the Radiation Oncology department for a CT scan. From this point until the catheters are removed you will be required to lie flat. It's important that you do not sit upright, as this places pressure on the inserted catheters and may dislodge them from their intended position.

You will have a urinary catheter in place until treatment is finished.

Step 3: Simulation CT scan

This CT simulation scanning procedure is similar to other scans you may have had. You will be lying on a moveable couch and pass through the CT scanner. Brachytherapy team members will perform the scan. Once the scan is complete, you will be admitted to the ward.

Step 4: Treatment planning

This step is performed without the patient present. The information gained from the CT scan described in step 3 is used by your Radiation Oncologist with the assistance of the radiation therapist and medical physicist to develop an accurate and customised treatment plan. Every plan is unique and tailored to the specific requirements of each patient. Once the treatment plan has been completed, approved by your Radiation Oncologist and had all required checks completed, your treatment is ready to commence.

Step 5: Brachytherapy treatment

HDR brachytherapy treatment is given in 2 fractions. The first fraction will be delivered in the early afternoon. You will be transferred from the ward to the Radiation Oncology department. An X-ray will be taken to check the position of the catheters as part of the treatment verification process. If required, physical adjustments are made to the catheter position by your Radiation Oncologist.

Each individual catheter is then connected via a transfer tube to the HDR Afterloader, a motorised unit which houses and controls the radioactive source that will deliver the treatment. Under computer control, the source will enter each catheter and stop at predetermined positions for a calculated time to deliver the required radiation treatment. Treatment delivery is painless and takes approximately 15minutes.

After the first fraction, the transfer tubes will be disconnected and you will return to the ward. The second fraction is delivered the following morning, usually at 8.00am. where the treatment process described above will be repeated.

Step 6: After HDR Treatment

After the second fraction you will be transferred to the ward for removal of the catheters and template. Pain relief is provided for this part of the process. Generally you will feel no effects of the treatment; however patients may experience tenderness and soreness where the catheters were inserted and template positioned. You will be free to sit up, and when ready, move around the ward. The urinary catheter will remain in position until the following morning, and removed prior to your discharge home.

Step 7: Follow up appointments

Two weeks after HDR brachytherapy you will commence the next phase of your radiation treatment. Before your discharge, a brachytherapy team member will visit you in the ward and provide you with appointment details. You will require a second CT scan to plan the external beam radiation therapy component of your treatment. The effectiveness of your brachytherapy and external beam treatment will be evaluated over time. The treatment is designed to stop the growth of the tumour and therefore it may take weeks to months before the full benefit of the treatment may be assessable. You will have regular follow-up appointments. Often imaging and diagnostic tests are required prior to these appointments. You will be provided with details if these are necessary.

Prostate Low-Dose Rate (LDR) Brachytherapy

Step 1: Initial consultation

Before you proceed for treatment your Radiation Oncologist will explain the brachytherapy process to you, and answer any questions you may have. Discussion will also take place with regard to treatment options and any potential short or long term side effects. An examination may be required at this appointment, along with review of any relevant X-rays, scan and test results, so please bring them along. Your next appointment will be for a prostate volume study.

Step 2: Volume Study

The volume study is a day procedure under general anaesthetic that requires the co-ordinated effort of a multi-disciplinary team: Radiation Oncologist, anaesthetist and radiation therapist. This is an important step in the prostate brachytherapy process, where the size of the prostate is measured and evaluated for treatment suitability. You will have a urinary catheter inserted. The procedure involves acquiring a series of ultrasound images guided by transrectal ultrasound.

The brachytherapy team will coordinate appointments for admission into hospital with you. You will receive a letter with all appointment details and preparation you need to undertake in the lead up to your procedure. The study itself will take approximately 30 minutes. A follow up appointment for Brachytherapy Seed Implant will be given at a later date.

Step 3: Treatment planning

This step is performed without the patient present. The information gained from the ultrasound scan in step 2 is used by your Radiation Oncologist with the assistance of radiation therapist to develop an accurate and customised treatment plan. Every plan is unique and tailored to the specific requirements of each patient. Once the treatment plan has been completed, approved by your Radiation Oncologist and had all required checks completed, the seeds for the treatment implant are ready to be ordered. The brachytherapy implant is scheduled for 3-4 weeks from the date of your volume study to allow time for your customised radioactive seed kit to be ordered and delivered.

Step 5: LDR Brachytherapy implant

This is a surgical procedure that requires the co-ordinated effort of a multi-disciplinary team; Radiation Oncologist, Urologist, anaesthetist, nurse, radiation therapist and medical physicist. You will have a general anaesthetic and remain in hospital overnight.

A urinary catheter is inserted for bladder management. The procedure involves the insertion and deployment of the radioactive seeds into the prostate gland through the perineum (area between anus and scrotum) guided by transrectal ultrasound. The seeds will remain in your prostate permanently. You will be admitted to the ward after the procedure.

Step 6: After implant

Your urinary catheter will be removed the following morning. After you successfully empty your bladder, you will be discharged home. You will be provided with a copy of discharge instructions to follow. A brachytherapy team member will contact you during the following week to arrange a follow up appointment with your Radiation Oncologist.

Step 7: Follow up consultation

An appointment will be made for you to have a CT scan of your prostate and see your Radiation Oncologist, both on the same day. The CT scan provides information for the evaluation of the treatment performance. The effectiveness of your brachytherapy treatment will be discussed at this appointment.

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