Brachytherapy: Why Chemotherapy May Soon Be a Thing of the Past

Brachytherapy is considered to be one of the oldest techniques for the treatment of various cancers, particularly for prostate cancer. From the Greek word “brachy,” meaning “short”, brachytherapy is a form of “short distance” internal radiation therapy where precise and high doses of radiation sources or “seeds” are embedded directly into the prostate. As far as treatments go, it is considered to be more effective and provides lesser side effects than other forms of treatment.

The global brachytherapy market is expected to reach $1.6 billion by 2015, with the U.S. representing fastest and most significant growth, according to a 2009 study by Global Industry Analysts, Inc. The report cites rising prevalence of cancer coupled with an increased awareness of risks of more invasive treatment. Brachytherapy treatment is now considered to be the preferred method of treatment for prostate cancer and a widely accepted treatment for head and neck cancer, cervical cancer and breast cancer.

A 2004 study published in the International Journal of Radiation Oncology Biology – Physics comparing the cure rate of brachytherapy to other treatments, particularly surgery or prostatectomy, high-dose external beam radiotherapy (EBRT) and combined seed implants with EBRT, determined the cure rates to be similar. Among patients who underwent five-year treatments, brachytherapy had a relapse-free survival rate of 83 percent as compared to 81 percent in radical prostatectomy and high dose EBRT. When it comes to life and death, a two percent difference is significant.  Succeeding clinical studies put the relapse-free survival rate within the range of 77 percent to 93 percent.

The side effects of brachytherapy should also be weighed against those of other treatments. It is normal among people undergoing prostate cancer treatments to experience urinary problems such as frequent urination and urgency, as well as slower urinary streams. These become more pronounced right after seed implants, thus the patient is advised to refrain from drinking and ingesting specific foods that could cause irritation to the bladder, including alcoholic beverages, apples, tea and others.

In brachytherapy, the tumor is targeted directly. Thus, the dose is uniform yet concentrated fully, minimizing adverse radiation effects to the healthy cells, tissues and organs surrounding the prostate. After the treatment, the catheter used to deliver the seeds is removed, leaving no traces or residues of the radioactive material in the body. Prolonged exposure to lingering radioactive material is why some doctors advise against the use of chemotherapy as treatment for cancers. The drugs used cause systemic damage to all cells.

The more obvious side effects in chemotherapy patients include hair loss, nail discoloration, mouth sores and gastrointestinal tract damage. However, the effects could be as far-reaching as to cause infertility and impotence, as well as adversely affect the blood, bone marrow and the central nervous system.

EBRT, on the other hand, can cause side effects on the urinary tract that could inevitably lead to incontinence. Meanwhile, since protastectomy is an invasive surgery, there are surgical risks to consider, aside from the usual potential for impotence and incontinence. Comparing all these side effects, it is clear that brachytherapy carries the least amount of risk, not to mention give greater chances of survival and a longer life.

Commonly used radiation sources for brachytherapy include: Cesium-137, Cobalt-60, Iridium-192, Iodine-125, Palladium-103 and Ruthenium-106. Major market players include: Best Medical International Inc.; BioCompatibles, Inc; C. R. Bard Inc.; Core Oncology; Cytogen Corporation; International Brachytherapy SA; Oncura, Inc.; Theragenics Corporation; Varian Medical Systems Inc.; Xoft Inc; and others.

IsoRay, Inc., a small public brachytherapy company, has drawn analyst interest with Cesium-131 seeds, which have a half-life just 9.7 days and achieve 90% dosage after 33 days. These dosage levels yield higher energy and half-life than the other commonly-used isotopes, which can increase treatment area and mitigate side effects.

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