2. Modalities of Radiotherapy
• BRACHYTHERAPY
• TELETHERAPY

3. BRACHYTHERAPY
• Internal radiation treatment achieved by
implanting radioactive material directly into
the tumor or very close to it.
• Sometimes called internal radiation therapy.
• Prefix “brachy” – from Greek for “short range”

4. TYPES OF BRACHYTHERAPY
1)Intracavitary irradiation using radioactive sources
that are placed in body cavities in close proximity
to the tumor and
2) Interstitial brachytherapy using radioactive
seeds implanted directly into the tumor volume.

5. WHY BRACHYTHERAPY
• Delivering the high dose of radiation to the
tumor
• Sparing of the surrounding normal tissues
• Delivered in a short period of time
– Tumor repopulation
• Limited to localized tumors

6. TELETHERAPY
• Teletherapy or External Beam Radiation
Therapy" involves delivery of therapeutic
radiation from a source
• that is placed away
• from the body.

7. INITIAL TREATMENT
2 Components of CA Cervix
• Central: Growth in the cervix which is
best treated by Brachytherapy
• Peripheral: Growth in parametrium &
lymph node metastasis which is best
controlled by Teletherapy

8. PRINCIPLES OF MANAGEMENT
• Patients with Stage I - IIA can be managed by
surgery alone.
• Patients in Stage IIB - IV
CHEMORADIATION
– Brachytherapy followed by Teletherapy
4 –6 weeks later.
– Chemotherapy

9. PRINCIPLES OF MANAGEMENT
• The relative proportion of Teletherapy
increases with bulk & stage of tumor.
• Usually Brachytherapy followed by
teletherapy 4 to 6 weeks later.

10. INDICATIONS FOR EBRT PRIOR TO
BRACHYTHERAPY
• Bulky tumours
• Distorted cervical canal
• Exophytic or bleeding tumors
• Tumors with necrosis or infection

11. ROLE OF CHEMOTHERAPY
Certain chemotherapeutic drugs such as
Cisplatin, carboplastin , 5 FU etc act as
radiosesitizers & may be given prior to any
form of radiotherapy to enhance the lethal
effect of radiation.

12. BRACHYTHERAPY
PRERADIATION PREPARATION
• Hb level
• Rectal enema
• Antibiotic cover

13. TANDEM & OVOID METHOD
• Under GA
• Bladder Catheterisation
• Cervical dilation
• Tandem & ovoids insertion
• X ray of pelvis
• Afterload technique

14. ICBT Procedure Overview
Patient Applicator
Preparation Check
Applicator
Treatment
implantation Imaging
Planning
and fixation
Treatment
excution

15. Patient Preparation
• GA
• Lithotomy position
• Perineal area is
disinfected
• Draping
• Catheterization

16. •Applicator set is check for
L/e
integrity and completeness
•Uterine sounding
•Correct size of ovoid is selected
and mounted onto the ovoidtubes
•Dilatation of the cervix
•Length of uterus is measured

17. IU- Tube Insertion
• Correct length of IU- •Select proper size ovoids
tube is selected and •Fixate these to the ovoid tubes
inserted •Insert one by one and attach to the
fixing mechanism

18. Applicator packing
• Insert gauze packing to
push rectum and
bladder away reducing
the dose to these
organs
• Radio opaque rectal
marker inserted

19. Verification X-ray
X-ray catheters

20. TECHNIQUES OF BRACHYTHERAPY
• PARIS METHOD
• STOCKHOLM METHOD
• MANCHESTER TECHNIQUE

21. PARIS METHOD
•Radium is applied continously for
5 days.
•Removed daily for cleaning and
reinserted back.

22. STOCKHOLM
•Radium is inserted on 3 occasions
•1 week interval between 1st & 2nd
insertion
•2 week interval between 2nd & 3rd
insertion

23. MANCHESTER
•Two Insertions
•Each insertion lasts for 72hrs
•1 week interval between two
insertions

24. PRINCIPLES IN BRACHYTHERAPY
• Uniform distribution to avoid Hot & Cold spots
• Two points
 Point A - -The point A was described fixed point
2cm lateral to uterine axis and 2 cm above the
lateral fornix.
It represents Anatomical location of Ureter.
Dose not to exceed 8000 rads

25. PRINCIPLES IN BRACHYTHERAPY
Point B: 5cm from the patient’s midline, at the
same level as point A.
It represents Lateral pelvic wall
Dose not to exceed 500o rads

26. TELETHERAPY
• SSD(Source to Skin Distance) is 5 to 10 times
the depth of tumour.
• Cobalt-60 and Caesium-137 are commonly
used
• Fractionated radiotherapy is preferred

27. TELETHERAPY
• Pelvic Radiation: 180 – 200 cGy
• Abdominal Radiation: 100 – 120 cGy
• About 4-5 fractions per week is given
• Total of 25 – 30 fractions is given over 5-6
weeks

28. COMPLICATIONS
• EARLY COMPLICATIONS
 Nausea & Vomiting
Bladder irritation: Dysuria & Haematuria
Rectal irritation : Tenesmus & diarrhoea
Malaise & Irritability
Pyelonephritis & Cystitis
Sepsis

29. COMPLICATIONS
• LATE COMPLICATIONS
 Persistent Anemia
Chronic pelvic pain due to fibrosis
Pyometra
Ulcers, Strictures & fistula
Osteoporosis
Ovarian distructions causing menopausal
symptoms