BRACHYTHERAPY:
INTERNAL RADIATION THERAPY
A complete guide to brachytherapy โ how radiation delivered from inside the body achieves high tumour doses with precision, which cancers it treats, HDR vs LDR techniques, eligibility, and international access through CancerFax.
analyticsAt a Glance
- check_circleBrachytherapy places a radioactive source inside or next to the tumour โ delivering high dose at short range while sparing surrounding tissue.
- check_circleStandard of care for cervical, prostate, endometrial, and breast cancers โ often combined with external beam radiotherapy.
- check_circleHDR brachytherapy uses a high-activity source for short-duration sessions; LDR uses low-activity seeds left permanently or temporarily in the tissue.
- check_circleAvailable in India (USD 2,000-8,000) and China at a fraction of Western costs, with specialist centres in both countries.
What Is Brachytherapy?
Brachytherapy is a form of radiation therapy in which a radioactive source is positioned inside or immediately adjacent to a tumour. The name derives from the Greek brachys, meaning short, reflecting the short distance over which the radiation travels. This short-range delivery allows very high doses at the tumour while surrounding normal tissue is largely spared.
โWhere external beam radiotherapy aims a beam from outside, brachytherapy places the radiation source directly at the target โ close-range precision that reduces dose to healthy tissue.โ
High-Dose-Rate (HDR) Brachytherapy
A high-activity radioactive source (typically Iridium-192) is temporarily inserted into the tumour or cavity for minutes at a time using afterloading equipment. HDR allows outpatient treatment in multiple brief sessions, with precise computer-controlled source positioning. Standard for cervical, endometrial, and breast cancer.
Low-Dose-Rate (LDR) Permanent Seed Implant
Small radioactive seeds (typically Iodine-125 or Palladium-103) are permanently implanted into the prostate under ultrasound guidance in a single procedure under anaesthesia. Seeds deliver dose continuously over weeks to months as the radioactivity decays. The gold standard for low and intermediate-risk prostate cancer.
Intracavitary Brachytherapy
A specialised applicator is inserted into a body cavity (uterus, vagina, rectum) and the radioactive source loaded into it. Most commonly used for cervical and endometrial cancer. MRI-guided intracavitary brachytherapy is the current standard of care for locally advanced cervical cancer.
Interstitial Brachytherapy
Radioactive sources are inserted directly into tumour tissue using thin needles or catheters. Used for breast cancer (accelerated partial breast irradiation), head and neck tumours, soft tissue sarcomas, and prostate cancer in some protocols.
Brachytherapy Techniques: HDR, LDR, and Intracavitary Compared
The right brachytherapy technique depends on cancer type, location, treatment goals, and patient factors.
| Feature | HDR Brachytherapy | LDR Permanent Seeds | Intracavitary (MRI-guided) |
|---|---|---|---|
| Radioactive source | Iridium-192 (temporary) | Iodine-125 / Palladium-103 (permanent) | Iridium-192 via ring/tandem applicator |
| Source duration | Minutes per session | Weeks to months (decays in situ) | Minutes per fraction |
| Primary indication | Cervical, endometrial, breast, H&N | Prostate cancer | Locally advanced cervical cancer |
| Hospitalisation | Outpatient (most cases) | Day case / 1 night | Day case to 1-2 nights per fraction |
| Number of sessions | 1-7 fractions (indication dependent) | Single implant procedure | 3-5 fractions (combined with EBRT) |
| Image guidance | CT or MRI-guided applicator placement | Ultrasound-guided implant | MRI-guided contouring per fraction |
| Combined with EBRT | Yes โ standard for most indications | Monotherapy or combined | Yes โ standard for cervical cancer |
Which Cancers Is Brachytherapy Used to Treat?
Brachytherapy is standard of care for several cancer types and plays a critical role that cannot always be replicated by external beam techniques alone.
Cervical Cancer โ The Most Important Indication
For locally advanced cervical cancer, brachytherapy combined with external beam chemoradiotherapy is the standard curative treatment. Omitting brachytherapy and replacing it with EBRT boost significantly worsens local control and survival. MRI-guided adaptive brachytherapy (EMBRACE-II protocol) is the current international standard.
Prostate Cancer
LDR permanent seed implant achieves excellent long-term biochemical control for low and intermediate-risk prostate cancer, with outcomes comparable to radical prostatectomy and EBRT. HDR brachytherapy boost combined with EBRT is an option for higher-risk disease.
Breast Cancer
Accelerated partial breast irradiation (APBI) using multicatheter interstitial or balloon brachytherapy delivers treatment in 5 days rather than 3-6 weeks of whole-breast EBRT. An evidence-based option for selected low-risk early breast cancer after lumpectomy.
Endometrial Cancer
Vaginal brachytherapy (vault brachytherapy) after hysterectomy for uterine cancer reduces vaginal vault recurrence. HDR vaginal cylinder brachytherapy is standard adjuvant treatment for intermediate and high-intermediate-risk endometrial cancer.
The Brachytherapy Treatment Process
The process varies by technique and indication. This overview covers the typical HDR intracavitary brachytherapy pathway for cervical cancer.
- 1
Specialist Consultation and Multidisciplinary Review
Radiation oncologist reviews pathology, imaging, prior treatment, and treatment goals. Tumour board input is standard. Eligibility for brachytherapy confirmed.
- 2
MRI-Guided Treatment Planning
High-quality MRI with applicator in situ (or pre-implant MRI) defines the tumour volume and organs at risk precisely. 3D image-guided planning is now the standard for cervical cancer brachytherapy.
- 3
Applicator Insertion Under Anaesthesia
For intracavitary brachytherapy, a ring-and-tandem or tandem-and-ovoids applicator is inserted under general or spinal anaesthesia. For LDR prostate implant, needles are placed under transrectal ultrasound guidance.
- 4
HDR Source Loading and Dose Delivery
The high-activity source travels through each dwell position inside the applicator for precisely calculated dwell times, delivering the dose distribution as planned. Each fraction takes minutes.
- 5
Applicator Removal and Recovery
For HDR, the applicator is removed after each fraction. The patient is monitored briefly and typically discharged the same day. Multiple fractions are delivered over several days to weeks depending on the protocol.
Brachytherapy Costs: India and China vs Western Centres
Brachytherapy requires specialist infrastructure and expertise. India and China offer this at significantly lower cost.
HDR Brachytherapy Course (Cervical Cancer, 5 Fractions)
- India (specialist centres)USD 2,000-6,000
- China (major cancer hospitals)USD 2,500-7,000
- EuropeUSD 10,000-25,000
- USAUSD 20,000-55,000
LDR Permanent Seed Implant (Prostate Cancer)
- IndiaUSD 4,000-10,000
- ChinaUSD 5,000-12,000
- USAUSD 30,000-60,000
Key Evidence Numbers
- 90-95%5-Year Local Control โ Locally Advanced Cervical Cancer (MRI-guided HDR)EMBRACE study outcomes with MRI-guided adaptive brachytherapy boost.
- 92-97%10-Year Biochemical Control โ Low-Risk Prostate Cancer (LDR Seeds)Long-term prostate-specific antigen control with permanent seed implant.
- 5 daysTreatment Duration โ APBI Brachytherapy for Breast Cancervs 3-6 weeks for conventional whole-breast external beam radiotherapy.
- 3-5Fractions โ HDR Brachytherapy Boost (Cervical Cancer)Combined with 45-50 Gy external beam chemoradiotherapy.
Related Guides in the Radiation Therapy Library
Explore specific brachytherapy topics and related radiation techniques.
Frequently Asked Questions
About Brachytherapy
Is brachytherapy painful?
Applicator insertion is performed under general or spinal anaesthesia, so patients are comfortable during the procedure. After removal, mild discomfort, cramping, or pressure may be felt for a few hours. HDR treatment delivery itself takes only minutes and causes no sensation.
Can brachytherapy replace external beam radiotherapy for cervical cancer?
For locally advanced cervical cancer, brachytherapy is not a replacement for external beam radiotherapy โ it is a mandatory boost that completes the curative treatment. Studies clearly show that replacing brachytherapy with an EBRT boost significantly reduces local control and overall survival. Both components are required for optimal outcomes.
Is brachytherapy available in India and China?
Yes. India has strong brachytherapy infrastructure, particularly for cervical and prostate cancer, at centres including Tata Memorial Centre, Kidwai Memorial Cancer Institute, and Apollo Cancer Centres. China's major cancer hospitals including those affiliated with Fudan University and Sun Yat-sen University offer full brachytherapy services. Both countries offer treatment at a fraction of Western costs.
How CancerFax Helps
CancerFax is a specialist cancer access and patient-navigation platform. We help patients and families understand their options, organise medical records, coordinate hospital communication, and support cross-border treatment planning where appropriate.
We help collect and organise reports, scans, pathology, biomarker results, and treatment history for structured case review.
We communicate with hospitals or trial teams to assess whether a case may be suitable for further screening.
We support appointment coordination, document submission, translation, and direct communication with international departments.
For international patients, we help with practical coordination โ travel planning, hospital admission guidance, and local support.
If this option is not suitable, we help explore other relevant treatments, clinical trials, or advanced care pathways.
From inquiry through to follow-up, our coordinators provide a single point of contact for the family.
CancerFax does not guarantee treatment access, eligibility, or clinical outcome. Our role is to help patients access accurate information, structured review, and appropriate specialist pathways.
Is Brachytherapy Part of Your Treatment Plan?
Upload your medical reports and imaging โ our radiation oncology team will review your case and connect you with experienced brachytherapy centres in India, China, and internationally.
This content is for informational purposes only and does not constitute medical advice. All treatment decisions must be made in consultation with a qualified radiation oncologist.