In the field of oncology, the search for more effective treatments with less impact on patients’ quality of life is constant. In this scenario, brachytherapy emerges as a highly specialized form of radiation therapy that is frequently used in the treatment of gynecological cancer.
Compared to other techniques, it stands out for its ability to deliver high doses of radiation directly to the tumor, minimizing damage to surrounding healthy tissue. Thanks to this precision, gynecological brachytherapy has established itself as a mainstay in the management of tumors such as cervical cancer and endometrial cancer, offering many women an effective, safe, and less side-effect-prone treatment option.
In our blog, we want to offer you a clear and detailed overview of this advanced technique, explaining what it consists of, what types of cancer it is used for, and how it works.
What is brachytherapy in gynecological oncology?
Brachytherapy in gynecological oncology is a type of internal radiation therapy that involves placing a radioactive source directly inside or very close to the tumor. This approach allows high therapeutic doses of radiation to be delivered to a very precise area, which is particularly useful in the female reproductive organs, such as the uterus, cervix, and vagina.
Unlike external radiation therapy, where radiation passes through the skin to reach the target, brachytherapy allows a high, concentrated dose of radiation to be delivered to a very specific area.
This approach minimizes exposure to surrounding healthy tissue, such as the bladder or rectum, resulting in a significant reduction in side effects. For this reason, brachytherapy for women is a cornerstone in the treatment of gynecological cancer.
This treatment is part of a multidisciplinary approach and is often combined with surgery, chemotherapy, or external radiation therapy, depending on the characteristics of the tumor and the patient’s overall condition.
What gynecological cancers are treated with brachytherapy?
Brachytherapy is a key treatment option for several types of cancer of the female reproductive system. Its use is well established in:
- Cervical cancer: This is one of the most common and effective indications, both in the early and advanced stages. Brachytherapy is an essential component of curative treatment, often in combination with external radiation therapy.
- Endometrial cancer (body of the uterus): it is frequently used after a hysterectomy (removal of the uterus) to reduce the risk of the cancer returning in the vaginal vault.
- Vaginal cancer: Brachytherapy may be the primary treatment or used as a boost after external radiation therapy to treat vaginal tumors.
- Vulvar cancer: The use of brachytherapy in this type of cancer is less common, but in selected cases it may be used to treat specific areas and avoid extensive surgery.
The choice of gynecological brachytherapy depends on multiple factors, such as the type of tumor, its extent, and whether the patient has already received other cancer treatments.
How does brachytherapy work in cervical and endometrial cancer?
The principle of brachytherapy is simple but powerful: attack the cancer from within.
- In cervical cancer: Treatment is planned meticulously. Using special applicators (small tubes or cylinders), which are inserted through the vagina until they reach the cervix and uterus, the radioactive source is placed. This source emits radiation in a controlled manner for a specific period of time, destroying the tumor cells with great precision.
- In endometrial cancer: after surgery, the aim is to irradiate the upper part of the vagina (vaginal vault), an area at risk of recurrence. To do this, a cylindrical applicator is inserted into the vagina. The radioactive source travels through the applicator, releasing the dose of radiation needed to eliminate any remaining cancer cells. The procedure is short and generally very well tolerated.
Both applications share a common advantage: better protection of neighboring structures such as the bladder or rectum, which translates into fewer side effects and a better quality of life for the patient.
Types of brachytherapy used in gynecological cases.
Gynecological brachytherapy can be classified mainly according to the rate of radiation dose administered:
- High-dose-rate brachytherapy (HDR): This is currently the most common modality. It consists of administering high doses of radiation in a few minutes, in separate sessions. The high-activity radiation source is placed in the applicators for a short period of time, usually a few minutes. It is performed on an outpatient basis or with a short hospital stay and offers great comfort for the patient.
- Low-dose rate brachytherapy (LDR): involves the use of a less active radiation source that is left in place for a longer period (one or more days). This type of treatment requires hospitalization for the duration of the application.
- Pulsed brachytherapy (PDR): combines features of HDR and LDR, delivering small doses at regular intervals.
In addition, depending on the placement of the source, it can be:
- Intracavitary: the radioactive source is placed in a body cavity, such as the uterus or vagina.
- Interstitial: thin needles or catheters are inserted directly into the tumor tissue. This technique is reserved for irregularly shaped or large tumors.
The choice of brachytherapy will be individualized, depending on the location of the tumor and the clinical characteristics of the patient.
When is brachytherapy recommended for women?
The recommendation for brachytherapy in women depends on a thorough analysis by a multidisciplinary oncology team. It is generally considered a priority option in the following situations:
- As a fundamental part of the radical treatment of locally advanced cervical cancer, combined with external radiotherapy and, in some cases, chemotherapy.
- To reduce the risk of recurrence in endometrial cancer after surgery, especially in intermediate stages.
- In patients with gynecological cancer who are not candidates for surgery due to other medical conditions.
- As a treatment for vaginal tumors, either alone or in combination with other therapies.
In general, female brachytherapy is recommended at various stages of gynecological cancer treatment. As a primary treatment, especially in locally advanced cervical cancer. As adjuvant therapy after surgery to prevent recurrence. As a palliative treatment in advanced or recurrent stages to control symptoms and improve quality of life.
The final decision will always be personalized, taking into account the type and stage of the tumor, the patient’s anatomy, and her overall health. The medical team evaluates each case individually, assessing the clinical benefits and possible risks. Thanks to its precision and efficacy, brachytherapy in gynecological cases represents a cutting-edge therapeutic tool that offers high cure rates and better preservation of quality of life for thousands of women each year.