Essential Radiotherapy Techniques – Brachytherapy
What is brachytherapy?
Brachytherapy is a highly specialised and resource intensive radiotherapy technique. Brachytherapy involves the placement of radioactive sources in, or just next to, a cancer. Unlike external beam radiotherapy, brachytherapy may be invasive. During brachytherapy, the radioactive sources may be left in place permanently or only temporarily, depending upon the radioactive isotope employed. Brachytherapy may be used alone or in conjunction with external radiation treatments.
Two types of brachytherapy
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High-dose-rate (HDR) brachytherapy involves the remote placement of the powerful radiation source into the tumour for several minutes through a catheter. It is usually given in multiple doses once or twice daily or once or twice weekly.
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Low-dose-rate (LDR) brachytherapy involves the longer placement of the temporary (several days) or permanent radiation source into the tumour area.
Conditions treated with brachytherapy
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Prostate cancer
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Gynaecological cancers
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Breast cancers
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Cancers of the eye
This list covers commonly treated conditions but cannot include every possibility.
Brachytherapy services across Australia 14
Less than half of all radiation oncology centres in Australia offer some form of brachytherapy service (45%). Northern Territory is the only Australian State or Territory that does not currently have any brachytherapy services.
High-dose-rate brachytherapy (HDR BT) is offered in 22 centres (42 %) nationally and in all jurisdictions excluding Northern Territory. 70% of HDR BT equipment is located in the public sector, while the remaining 30% is located at privately owned facilities.
HDR BT equipment distribution
| State | Percentage of total machines |
|---|---|
| ACT | 5% |
| NSW | 32% |
| QLD | 19% |
| SA | 14% |
| TAS | 3% |
| VIC | 19% |
| WA | 8% |
| NT | 0% |
Low-dose-rate brachytherapy (LDR BT) is offered in only 14 centres nationally (27%). In 2010 Australian Capital Territory, Northern Territory and Tasmania did not offer any LDR BT services. This has since changed for ACT and Tasmania. In Queensland, LDR BT services are not available in the public hospital system.
LDR BT service volume
| State | Percentage of total LDR BT courses delivered |
|---|---|
| ACT | 0% |
| NSW | 24% |
| QLD | 15% |
| SA | 23% |
| TAS | 0% |
| VIC | 32% |
| WA | 6% |
| NT | 0% |
Trends and issues arising
Brachytherapy services are changing and developing along with other oncological and radiotherapy services. The screening and vaccination programs across Australia should ultimately result in reduced referrals for gynaecological brachytherapy overall. This, however, is anticipated to be offset to some extent by the increasing complexity of the gynaecological cases requiring brachytherapy, as these cases are often late stage disease.
Significant growth is expected to continue in the demand for prostate cancer brachytherapy. Current evidence-based reports suggest brachytherapy has a favourable cost-effectiveness compared with other active treatments for prostate cancer. Prostate cancer is the most common internal cancer, and increasing rapidly in incidence with population growth and aging. These factors are likely to lead to a demand for brachytherapy services. The potential introduction of prostate cancer screening services is likely to increase the demand for early brachytherapy (low-dose-rate) in particular.