HDR

High Dose Rate (HDR) brachytherapy is an advanced cancer treatment offered to Pocono cancer patients and many others from all over the world. Sources known as radioactive seeds are placed in or near the tumor itself, giving a high radiation dose to the tumor while reducing the radiation exposure in the surrounding healthy tissues. The term "brachy" is Greek for short distance, and brachytherapy is radiation therapy given at a short distance: localized, precise, and high-tech.

As explained in the Radiation section , brachytherapy is a form of radiation treatment that uses radiation placed very close to or inside the tumor. The radiation source is usually sealed in a small holder called an implant. Implants may be in the form of thin wires, plastic tubes called catheters, ribbons, capsules, or seeds. The implant is put directly into the body.

Internal radiation is usually delivered in one of two ways, each of which is described below. Both methods use sealed implants:

• Interstitial radiation therapy is inserted into tissue at or near the tumor site. It is used to treat tumors of the head and neck, prostate, cervix, ovary, breast, and perianal and pelvic regions. Some women treated with external radiation for PA breast cancer treatment receive a booster dose of radiation that may use interstitial radiation or external radiation.
• Intracavitary or intraluminal radiation therapy is inserted into the body with an applicator. It is commonly used in the treatment of uterine cancer. Researchers are also studying these types of internal radiation therapy for other cancers, including breast, bronchial, cervical, gallbladder, oral, rectal, tracheal, uterine and vaginal.

Given on an outpatient basis, HDR is used to treat a variety of different types of cancers including lung, gynecologic, breast, brochial, esophageal, prostate, biliary and head/neck cancers ? there have even been successful PA skin cancer treatment reports. Treatments are generally given in three to ten sessions, lasting five to 20 minutes, once a week. These short courses of high doses maximize the effects of the radiation.

The benefits of HDR are that no hospital stay is required, a high dose of radiation is delivered in a shorter period of time than conventional therapy, it is more comfortable for the patient, offers fewer side effects, is non-invasive, more accurate, and more convenient.

What to expect:
First, your physician will decide which type of implant will be required based on the location, stage and size of the cancer and other factors. There are three types of implants (discussed above): intracavitary, intraluminal and interstitial.

After the implants are inserted, either a CT scan or special X-ray is taken by the radiation therapist to determine the exact location of the implant in the body and the relationship to adjacent organs.

Once the implants are in place, the CT images or films are given to the dosimetrist to enter into the treatment planning computer. The computer does the initial calculation, but it is the dosimetrist who fine tunes the radiation doses to conform to the target volume while minimizing the doses to the nearby normal tissue. After the treatment plan has been approved by the physician, the computer transfers the treatment plan instructions to the HDR remote afterloader ? the machine that administers the radiations source.

In the treatment room, the ends of the applicator or treatment catheters that protrude outside of your body are connected to transfer tubes that are then connected to the HDR afterloader. The programmed instructions tell the afterloader where to direct the source and how long the source will stay in each position. You will be alone in the treatment room while the treatment is being given, but the therapists and nurses are continually monitoring you. The time the source spends in the implant is about 10 to 15 minutes.

The entire treatment process takes about 30-60 minutes. These time estimates can vary depending on the size and complexity of the implant. When the treatment is completed, the radiation source is retracted back into the HDR afterloader. There is no radiation left behind in your body and you don't have to worry about being radioactive.

After all treatments have been given (often several times over the course of a few days or weeks), the implants are removed. Intracavitary and intraluminal applicators are simple to remove and you can typically go home soon after removal. With interstitial implants, sutures holding the template and/or catheters in place are clipped and the implant is gently removed. Some minor bleeding usually occurs. The Cancer Center nurses will give you post-implant skin care instructions and make sure that you schedule a follow-up appointment before you leave.
It is important to keep the cancer center informed of your recovery, including any discomfort or side effects that you may experience.
For more information about HDR brachytherapy or whether this treatment might be an option for you or a loved one, please contact the Hughes Cancer Center at 570-476-3488 to schedule a consultation.