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Summary

Internal radiation is radiation delivered by radioactive material inserted into the body as a liquid which runs through the entire body, or as a solid placed in or near a tumor. There are several types of internal radiation therapy in use today. Brachytherapy and Intraoperative radiation therapy (IORT). This article only deals with brachytherapy. Brachytherapy is the insertion of tiny amounts of radioactive material temporarily placed into or near the tumor.  Before your first session, there will be a planning session. It is advisable to take a family member of friend with you to the meeting to help ask questions, recap what was said after the meeting, and to provide emotional support.

There are do's and don'ts to be aware of during treatment.

Side effects during treatment are controllable. There may also be long term side effects. Long term side effects from radiation treatment for breast cancer may be different than those for other tumor types.

For additional information see: Radiation Treatment In General

Types Of Internal Radiation Treatment: Brachytherapy

With internal radiation (brachytherapy), radioactive material is inserted into the body either:

  • Sealed in needles, seeds, wires or catheters placed directly into or near a tumor. Internal radiation allows a higher dose of radiation to a smaller part of your body. This treatment is known as Brachytherapy.
  • Or by means of a liquid that you drink.

There are three types of brachytherapy:

  • Low-dose rate (LDR) implants. In this type of brachytherapy, radiation stays in place for 1 to 7 days. You are likely to be in the hospital during this time. Once your treatment is finished, your doctor will remove the radiation sources and your catheter or applicator.

  • High-dose rate (HDR) implants. In this type of brachytherapy, the radiation source is in place for 10 to 20 minutes at a time and then taken out. You may have treatment twice a day for 2 to 5 days or once a week for 2 to 5 weeks. The schedule depends on your type of cancer. During the course of treatment, your catheter or applicator may stay in place, or it may be put in place before each treatment. You may be in the hospital during this time, or you may make daily trips to the hospital to have the radiation source put in place. Like LDR implants, your doctor will remove your catheter or applicator once you have finished treatment. 

  • Permanent implants. After the radiation source is put in place, the catheter is removed. The implants always stay in your body, while the radiation gets weaker each day. You may need to limit your time around other people when the radiation is first put in place. Be extra careful not to spend time with children or pregnant women. As time goes by, almost all the radiation will go away, even though the implant stays in your body.

Internal implants may be temporary or permanent. 

Before Your First Internal Radiation Treatment

You will have a 1- to 2-hour meeting with your doctor or nurse before you begin internal radiation therapy. At this timel:

  • You will:
    • Have a physical exam 
    • Talk about your medical history 
    • Maybe have imaging tests. 
  • Your doctor will discuss:
    • The type of internal radiation therapy that is best for you
    • Its benefits 
    • Common side effects, 
    • Ways you can care for yourself during and after treatment.

How Internal Radiation Is Put Into Place

Most brachytherapy is put in place through a catheter. A catheter is a small, stretchy tube. Sometimes, it is put in place through a larger device called an applicator. When you decide to have brachytherapy, your doctor will place the catheter or applicator into the part of your body that will be treated. 

 You will most likely be in the hospital when your catheter or applicator is put in place. Here is what to expect:
  • You will either be put to sleep or the area where the catheter or applicator goes will be numbed. This will help prevent pain when it is put in.

  • Your doctor will place the catheter or applicator in your body. 

  • If you are awake, you may be asked to lie very still while the catheter or applicator is put in place. If you feel any discomfort, tell your doctor or nurse so he or she can give you medicine to help manage the pain.

How long the radiation is in place depends on which type of brachytherapy you get, your type of cancer, where the cancer is in your body, your health, and other cancer treatments you have had. 

What Happens While Internal Radiation Is In Place

Your body will give off radiation once the radiation source is in place.

With brachytherapy, your body fluids (urine, sweat, and saliva) will not give off radiation.

With liquid radiation, your body fluids will give off radiation for a while.

Your doctor or nurse will talk with you about safety measures that you need to take. If the radiation you receive is a very high dose, safety measures may include:

  • Staying in a private hospital room to protect others from radiation coming from your body
  • Being treated quickly by nurses and other hospital staff. They will provide all the care you need, but they may stand at a distance and talk with you from the doorway to your room.
  • Your visitors will also need to follow safety measures, which may include:
    • Not being allowed to visit when the radiation is first put in
    • Needing to check with the hospital staff before they go to your room
    • Limiting the length of visits (possibly to 30 minutes or less each day). The length of visits depends on the type of radiation being used and the part of your body being treated.
    • Standing by the doorway rather than going into your hospital room
    • Not having visits from children younger than 18 and pregnant women

You may also need to follow safety measures once you leave the hospital. For example, the amount of time you may spend with any one person may be limited. Your doctor or nurse will talk with you about the safety measures you should follow when you go home.

When the catheter is taken out after treatment with LDR or HDR implants:

  • You will get medicine for pain before the catheter or applicator is removed.
  • The area where the catheter or applicator was might be tender for a few months.
  • There is no radiation in your body after the catheter or applicator is removed. It is safe for people to be near you - even young children and pregnant women.
  • For 1 to 2 weeks, you may need to limit activities that take a lot of effort. Ask your doctor what kinds of activities are safe for you.

 

Side Effects

Side effects are problems that can happen as a result of treatment. They may happen with radiation therapy because the high doses of radiation used to kill cancer cells can also damage healthy cells in the treatment area. Side effects are different for each person. Some people have many side effects; others have hardly any. Side effects may be more severe if you also receive chemotherapy before, during, or after your radiation therapy.

Talk to your radiation therapy team about your chances of having side effects. The team will watch you closely and ask if you notice any problems. If you do have side effects or other problems, your doctor or nurse will talk with you about ways to manage them. 

Depending on the part of your body being treated, you may have the following side effects:

Most of these side effects go away within two months after radiation therapy is finished.

What To Do And Not Do While You Undergo Radiation

  • Consider having someone go with you to the planning visit both for emotional support and to help ask questions. Also consider taking a recorder to record the conversation so you can review it later.
  • Do not take vitamins, minerals, herbs, antioxidants or other supplements without first asking your doctor, nurse or dietitian whether it is okay. Some of these substances can be harmful. Some may reduce the effectiveness of the radiation therapy.
  • To the extent possible, avoid scratching the treated area. Scratching can cause infection or soreness.
  • Wear soft, loose clothing that doesn't irritate the treated area.
  • If medical personnel suggest or allow you take vitamins, minerals, herbs, antioxidants or other supplements, do not take more than is recommended without first checking with medical personnel.

If A Breast Will Be Radiated

  • If you need to wear a bra, it is advisable to go to a shop that has a professional fitter. Try on all the bras that could work for you. Consider buying only one of the most comfortable and trying it out for a few days or a week before buying another one. The bra can be washed every night.
  • Ask which deodorants are okay to use, and which aren't.

Breast Cancer Radiation: Long Term Side Effects

There is no evidence that today's radiation will cause a later cancer in either the treated breast or in the other breast.

Menstrual periods and fertility are not affected.

If you want to breast feed a baby, you will probably not be able to do it with a breast that has received radiation. The other breast will be able to lactate.

Most swelling usually disappears after a few weeks. If the radiation is near the nipple and areola, the swelling may take longer to subside.

A treated breast is usually firmer than normal. In some patients, the breast may become smaller or larger.

Other symptoms which have been reported are:

  • A feeling of warmth in the treated breast that continues for months after the end of treatment. 
  • Changes in sensation in the treated breast.