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The Good Seed 

Brachytherapy, or seeding, is a way to treat cancer during a long lunch break

In 2011, options for treating cancer abound, and they are improving all the time. A proven cancer treatment that has yielded extremely positive results over the years is brachytherapy.

  With brachytherapy, also called seeding or internal radiation therapy, radiation is used to eradicate tumors from the inside out instead of using external beam radiation therapy, which directs radiation from the outside in. Brachytherapy allows physicians to place radioactive material inside or near a tumor. The radioactive sources' precise locations permit physicians to use higher doses of radiation than are safe with external beam therapy and for shorter periods of time. That causes less damage to healthy tissues surrounding the diseased area.

  Urologist Walter Levy with East Jefferson General Hospital has performed brachytherapy in prostate cancer patients for more than 30 years. "Given the right patient, the results have been excellent." However, this type of treatment cannot be used in patients with a very large prostate or an advanced stage of cancer, Levy says. In those cases, surgery or external radiation therapy is more appropriate, he says. An experienced, knowledgeable health care team is crucial for identifying candidates for successful brachytherapy. "Our team knows how to do a great job, but (we) also know how to select appropriate candidates for the procedure," Levy says. "We have very experienced radiation oncologists, urologists and physicists working together to perform this procedure."

  Depending on what a patient needs, one of two kinds of brachytherapy can be employed for cancer treatment. In Low Dose Radiation (LDR) brachytherapy, several needles are used to implant small, radioactive seeds directly into or near the tumor. Although the seeds remain in the body permanently, the radioactive material dissipates completely over a few months and become harmless.

  In High Dose Radiation (HDR) brachytherapy, a needle or catheter delivers radiation to a specific location then is removed, along with the radiation, before the patient leaves the hospital. This procedure often requires an overnight hospital stay and can be more challenging for patients.

  A patient's length of stay in the hospital depends on the course of treatment prescribed by his or her physician. In many cases, brachytherapy is a relatively quick outpatient procedure that can be completed in 30 to 45 minutes, allowing the patient to be in and out of the hospital in a matter of hours.

  "Patients are asleep while the procedure is done," Levy says. "Afterward, they go home and hardly have any pain. We remove the catheter the next day and that's it. They don't have an incision. They haven't had major surgery. There are all kinds of benefits, and it's quick. I've had guys go back to work within a couple of days."

  Brachytherapy has been used effectively to treat many different types of cancer including breast, cervix, eye, gallbladder, head and neck, lung, prostate, rectum, skin, uterus and vagina. It is an invaluable tool in treating prostate cancer, the second deadliest cancer for men older than 40 and the most diagnosed cancer in men, according to the National Cancer Institute. In 2000, The Journal of Urology published the results of a study conducted by the University of California. The study showed long-term side effects such as urinary incontinence were reduced in brachytherapy patients compared to men who underwent a radical prostatectomy. The study concluded, "At an average of 7.5 months after treatment, the general health-related quality of life of patients undergoing brachytherapy with and without pretreatment external beam radiation was similar to age-matched controls."

  Although physicians have used the treatment for decades, Levy attributes some of brachytherapy's recent success to evolving technology. "The ultrasound imaging of the prostate and the ability to place the seeds in real time means you know exactly where you are in the body," he says. "I know where all the seeds are and how close I am to vital structures. The technology has changed everything."

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