02 8382 6980 | Raji.Kooner@svha.org.au
St Vincent's Private Hospital | Mater Hospital, North Sydney | Bowral Office Staff Portal
Urology NSW
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High Dose Rate Bracchytherapy

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High dose rate bracchytherapy is an excellent treatment for prostate cancer.1

I’ve been doing that now for over 10 years.

It’s a way of giving what we call conformal radiotherapy2 where you get a much higher energy to the prostate.

So what we do is we put some wires into the prostate, that’s done under an anaesthetic, a short half hour procedure.

We put 20 wires in, the patient then goes off to the CT room later that morning and gets some planning done to work out exactly where the wires are and the physicist works out how much energy to put in each one of those wires.

So that afternoon they have a ray, a treatment where ray energy is given through the wires into the prostate and then they have another treatment the next morning and in the afternoon when the wires come out and the patient goes home the next day.

They then have a break for a week and then have five weeks of the external beam energy.

In this way we get a much higher dose of radiotherapy to the prostate with lower dosage to adjacent organs.3

So my preference usually is to do high dose rate bracchytherapy for patients but the prostate has got to be a certain size to get the wires in.

If the prostate is too large they may not be suitable for this4 and also sometimes we combine hormone therapy with radiotherapy so that we will use hormones for a period of about 12 months with the radiotherapy because studies have shown that hormones plus radiotherapy in active cancers gives better outcomes than just radiotherapy by itself.5,6

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High Dose Rate Brachytherapy

High dose rate (HDR) brachytherapy is an effective treatment option for prostate cancer1 that Dr Kooner has been performing for over 10 years. It is a form of conformal radiotherapy2 - a technique that delivers a much higher radiation dose directly to the prostate while keeping the dose to adjacent organs lower.3

How HDR brachytherapy works

  • Under anaesthetic, around 20 fine wires are placed into the prostate - a short procedure of about half an hour.
  • The patient then has a planning CT scan, where a physicist calculates precisely how much radiation each individual wire should deliver.
  • That afternoon, radiation is delivered through the wires into the prostate.
  • A second treatment is given the next morning, the wires are removed that afternoon, and the patient goes home the following day.
  • After a week’s break, a further five weeks of external beam radiotherapy is given to complete the treatment course.

Who is suitable

HDR brachytherapy is Dr Kooner’s preferred radiotherapy option for many patients, but the prostate has to be a certain size to accommodate the wires. If the prostate is too large, the technique may not be suitable.4

Combining with hormone therapy

For more active cancers, hormone therapy is often combined with radiotherapy, typically for around 12 months. Studies have shown that hormones plus radiotherapy give better outcomes than radiotherapy alone in this setting.5,6

Brachytherapy Patient Information Brochures

Brachytherapy planning for prostate cancer PDF Brachytherapy treatment for prostate cancer (permanent seed brachytherapy) PDF

References

References

  1. High dose-rate brachytherapy in the treatment of prostate cancer - Lucas C. Mendez and Gerard C. Morton - Transl Androl Urol. 2018 Jun; 7(3): 357–370 - doi: 10.21037/tau.2017.12.08
  2. Conformal radiotherapy for prostate cancer - GE Hanks - Ann Med. 2000 Feb;32(1):57-63 - doi: 10.3109/07853890008995911
  3. GEC/ESTRO recommendations on high dose rate afterloading brachytherapy for localised prostate cancer: an update - Peter J Hoskin, Alessandro Colombo, Ann Henry, et al - Radiother Oncol. 2013 Jun;107(3):325-32 - doi: 10.1016/j.radonc.2013.05.002
  4. Impact of Prostate Gland Size ≥60 cc on Physician and Patient-Reported Toxicity after High Dose Rate Prostate Brachytherapy - A.A. Harris, B. Martin, K. Stang, et al. - International Journal of Radiation Oncology - https://doi.org/10.1016/j.ijrobp.2018.07.31
  5. Radiotherapy combined with hormonal therapy in prostate cancer: the state of the art - Piotr Milecki, Piotr Martenka, Andrzej Antczak, et al. (2010) - Cancer Management and Research, 2, 243–253 - https://doi.org/10.2147/CMR.S8912
  6. Impact of hormonal treatment duration in combination with radiotherapy for locally advanced prostate cancer: Meta-analysis of randomized trials - Federica Cuppone, Emilio Bria, Diana Giannarelli, et al. - BMC Cancer 10, 675 (2010) - https://doi.org/10.1186/1471-2407-10-675