Internal radiotherapy
What is internal radiotherapy?
Internal radiotherapy uses a radioactive material that is put inside the body to treat cancer. This is called:
- brachytherapy, when a solid material is used
- radioisotope or radionuclide therapy, when a liquid is given by mouth or injection.
Your healthcare team can give you more information about these types of radiotherapy.
If you are having some types of internal radiotherapy, you may have to stay in hospital for a few days.
Is internal radiotherapy safe?
Your treatment is planned to give you the amount of radiation needed to treat the cancer safely and effectively. But your healthcare team are careful to protect other people around you from radiation.
Safety measures may be slightly different in different hospitals. Your team will explain what to expect.
Related pages
Brachytherapy
Brachytherapy uses radioactive sources that are put near or inside the tumour. These include:
- seeds
- pellets
- tubes
- plaques
- discs.
The radioactivity only affects tissue that is very close to the source. This means the tumour is treated, but healthy areas around it get much less radiotherapy. Areas of the body that are further away are not affected at all.
The source is left in place to give the correct dose of treatment. Depending on the type of brachytherapy, this may take a few minutes or a few days. Some sources are designed to stay in the body permanently.
Your healthcare team will explain your treatment plan. This may also involve external beam radiotherapy before or after brachytherapy or other treatments such as chemotherapy, hormonal therapy or targeted therapy.
Brachytherapy is mainly used to treat cancers in the prostate, cervix and womb. It is sometimes used to treat other cancers, such as cancer of the vagina, vulva, oesophagus (gullet), skin and rectum.
Brachytherapy for prostate cancer
There are 2 ways of giving brachytherapy for prostate cancer.
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Permanent seed implants
Permanent seed implant treatment is sometimes known as low-dose-rate (LDR) brachytherapy. Small radioactive seeds are put into the prostate under a general anaesthetic or spinal anaesthetic. This is an injection of painkillers into the spine. The seeds are not removed. They are left inside the body permanently to release radiation slowly. The seeds become less radioactive over several months..
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High-dose-rate (HDR) brachytherapy
HDR brachytherapy is given under a general or a spinal anaesthetic. A spinal anesthetic is an injection of painkillers into the spine. Thin tubes are put through the skin and into position in the prostate.
The ends of the tubes outside the body are connected to an HDR treatment machine. The machine sends a radioactive pellet into each tube. It keeps the pellets in the tubes in the prostate for up to an hour to give the treatment. When the treatment has finished, the pellets return to the machine. Sometimes 2 or 3 treatments are given over 24 hours. When all the treatment is finished, the tubes are removed..
Brachytherapy for cancers of the cervix, womb, vulva and vagina
Hollow tubes called applicators are placed into the vagina. One end of each tube sits inside the vagina or womb. The other end sits outside the body between the legs. If a tube is placed in the womb you may have a general anaesthetic or a spinal anaesthetic. A spinal anesthetic is an injection of painkillers into the spine.
The end of the tubes outside the body are connected to a treatment machine. The machine sends a radioactive pellet into each tube. The machine then gives the planned dose of radiation. When the treatment has finished the pellets return to the machine. The actual delivery of treatment will cause no pain or burns.
This type of brachytherapy can be given as:
- high-dose-rate treatment (HDR)
- pulsed-dose-rate treatment (PDR)
- low-dose-rate treatment (LDR).
These methods all work equally well. The type you have depends on the system your hospital uses.
We have more information about brachytherapy for cervical cancer.
Other cancers and brachytherapy
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Plaque brachytherapy
Eye cancer (ocular melanoma) may be treated using a small radioactive disc called a plaque. The plaque is placed near the cancer using a small operation. It is usually done under a general anaesthetic. But sometimes a local anaesthetic is used. The plaque is left in place, usually for 1 to 5 days. You have another small operation to remove it after the treatment. .
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Brachytherapy using an endoscope
An endoscope is a thin, flexible tube with a camera on the end. It can be used to look inside areas such as the nose, throat, airways or rectum.
An endoscope can be used to look for a tumour. When the tumour is found, the person doing the endoscopy puts a thin tube next to the tumour. A machine then sends radioactive pellets into the tube. It keeps the pellets in the tubes in place to give the treatment. After the treatment the pellets return to the machine.
Your healthcare team will give you more information if you are offered this treatment.
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Selective internal radiotherapy treatment (SIRT)
This type of brachytherapy may be used to treat some types of liver cancer. For example, it may be used to treat cancer that spreads to the liver from the bowel. Tiny radioactive beads are injected into the bloodstream. They stick permanently in small blood vessels in and around the liver tumour. The beads give off radiation which damages the cancer cells.
We have more information about SIRT.
Radiation safety during brachytherapy
You may have your treatment and go home on the same day or you may stay in hospital. This depends on the type of brachytherapy you have.
During your treatment in hospital you may be looked after in a single treatment room. You may need to be alone in the room at times. Tell your healthcare team if you are worried about this so they can help.
As soon as the source is removed from your body, there is no risk to people around you. You are not radioactive.
For some types of brachytherapy, the source is not removed. This includes permanent seed implants or SIRT. The radiation from each source is absorbed by the area of the body closest to it. It is safe for you to be around most people.
As a precaution, you may have to avoid close contact with children or people who are pregnant for a time. Your healthcare team will explain this and any other safety measures to you. They will give you information about your treatment to carry with you at all times.
Radioisotope therapy
This therapy uses radioactive liquids known as radioisotopes or radionuclides to destroy cancer cells. The liquid can be given:
- by mouth as a drink or capsules
- as an injection into a vein.
Cancer cells take in the radioisotope more than normal cells do. This means they get a higher dose of radioactivity. This eventually destroys the cancer cells.
Your radiotherapy team will tell you how you will have your treatment and any possible side effects.
Types of radioisotope therapy
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Iodine-131
This is the most common type of radioisotope therapy. It is mainly used to treat some types of thyroid cancer. You usually have it as capsules.
It may also be used to treat other rarer neuroendocrine tumours (NETS). In this case you have it as an injection into a vein in the arm. You may have to stay in hospital to have this treatment. -
Radium-223
This radioisotope is sometimes used to treat prostate cancer that has spread to the bones. It may be used if hormone therapy alone is no longer controlling the cancer and chemotherapy has already been used or is not a suitable option. You have it as an injection into a vein. You can usually go home soon after having this treatment.
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Lutetium-177
Lutetium-177 is used to treat some neuroendocrine tumours (NETS). It may be used to treat other cancers. You have it as an injection into a vein. You usually stay in hospital for this treatment.
Radiation safety during radioisotope therapy
After treatment, your body fluids are slightly radioactive for a time. Your healthcare team will give you instructions about using the toilet and cleaning up any spilled body fluids safely.
You may be advised to avoid close contact with children or people who are pregnant for a time.
If your treatment involves a stay in hospital, you may be cared for in a single treatment room. You may be asked to stay in your room at all times. Tell your team if you are worried about this so they can help.
Your team will tell you any other safety measures you need to follow.
Getting support
Macmillan is here to support you. If you would like to talk, you can do the following:
- Call the Macmillan Support Line on 0808 808 00 00.
- Chat to our specialists online.
- Visit our cancer treatment forum to talk with people who have had cancer treatment, share your experience, and ask an expert your questions.
About our information
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References
Below is a sample of the sources used in our radiotherapy information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
The Royal College of Radiologists. Radiotherapy dose fractionation. 3rd Edition. 2019. Available from www.rcr.ac.uk/system/files/publication/field_publication_files/brfo193_radiotherapy_dose_fractionation_third-edition.pdf.
Society and College of Radiographers. Practice guideline document. Radiation dermatitis guidelines for radiotherapy healthcare professionals. 2nd Edition. 2020. Available from www.sor.org/getmedia/53bd52ff-679e-48de-82a0-dc8dae570896/2020_version_4_final_practice_guideline_radiotherapy_skin_care_llv1.pdf.
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr David Gilligan, Consultant Clinical Oncologist.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
Date reviewed
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This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.
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