Disadvantages of brachytherapy

Many of the sources used in brachytherapy emit gamma rays and nursing and medical staff may be exposed inadvertently to low doses of radiation from the patient. Staff exposure can be minimized by afterloading techniques or the use of low energy radionuclides (see below).

Large tumours are usually unsuitable for brachytherapy. However, brachytherapy may be employed as a boost treatment following reduction in size by external beam radiotherapy and/or chemotherapy.

The radiation dose falls off rapidly from the sources, therefore, in order to treat the required tissue volume adequately, accurate geometric positioning is critically important. The spatial arrangement of sources used varies depending on the type of source applicator, the anatomical position of the tumour and the surrounding dose limiting normal tissue. Accurate positioning of sources or applicators requires special skill and training and this is not universally available.

Surrounding structures, such as lymph nodes that may contain overt or microscopic cancer, will not be irradiated by the implant or intracavitary treatment.

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