At a glance
Brachytherapy is a form of radiation therapy in which a radioactive source is placed directly inside or right next to a tumour, delivering a high dose of radiation to cancer cells from within.
Because the radiation travels only a short distance, it reaches the tumour at full strength while sparing much of the surrounding healthy tissue. The radioactive material is usually sealed inside a small capsule, wire, or seed. Depending on the plan, it stays in place for a few minutes, a few days, or permanently, and it gradually loses its radioactivity over time.
Medical Condition
Brachytherapy is used most often in gynaecological and other cancers where the tumour can be reached with an applicator (a device that holds the radioactive source in position).
- Cervical cancer (cancer of the cervix, the lower part of the uterus)
- Endometrial cancer (cancer of the lining of the uterus)
- Vaginal cancer
- Vulvar cancer
- Prostate cancer
- Head and neck cancers, including tongue and throat tumours
- Breast cancer, as a targeted boost after surgery
- Skin cancer, for surface tumours
- Eye cancer (ocular melanoma)
Brachytherapy is generally not suitable when the tumour is very large and widespread, when surrounding organs cannot tolerate any radiation, or when the anatomy makes safe placement of an applicator impossible. Patients who have already received the maximum safe dose of radiation to the same area are also usually excluded. Your oncologist will review imaging scans and your overall health before deciding whether it is the right option.
Risks & Complications
Brachytherapy is generally well tolerated, but like any radiation treatment it can cause side effects, most of which are related to the area being treated.
- Localised pain or discomfort in the treated area during or shortly after the procedure
- Swelling, bruising, or tenderness where the applicator was inserted
- Fatigue that can last days to weeks after treatment
- Frequent urination, burning when urinating, or difficulty emptying the bladder, especially after treatment near the pelvis
- Bowel changes such as diarrhoea, urgency, or rectal irritation
- Vaginal dryness, narrowing (stenosis), or discomfort during intercourse, in gynaecological cases
- Skin redness or irritation at the surface entry point
- Infection at the site where the applicator or implant was placed
- Rarely, damage to nearby organs such as the bladder or rectum (fistula formation), which may require further treatment
- A very small long-term risk of radiation-induced changes in surrounding tissue
Preparation & Procedure
Preparation varies depending on whether you are having a short, single session or a multi-day implant, but there are steps common to most brachytherapy plans.
On the dietary side, patients are usually asked to stop eating solid food for several hours before the procedure, since sedation or anaesthesia is often used during applicator insertion. Your care team will give you exact fasting times. Blood thinners and certain other medications are typically paused in the days beforehand, based on your doctor's instructions. Smoking and alcohol are discouraged in the weeks leading up to treatment, as both can slow healing and affect how tissue responds to radiation.
Before the first session, you will usually have an MRI (magnetic resonance imaging) or CT scan of the area so that doctors can map the tumour precisely and plan where the radioactive source will sit. Blood tests check your general health and clotting function. In gynaecological cases, a gynaecological examination under sedation is sometimes done to assess the size and shape of the uterus or vagina.
The procedure itself typically follows these steps:
- You change into a hospital gown and a nurse checks your vital signs (blood pressure, heart rate, oxygen level).
- Sedation, regional anaesthesia (numbing a part of the body), or general anaesthesia is given, depending on the type of applicator and your doctor's plan.
- The radiation oncologist (a doctor who specialises in cancer radiation treatment) places the applicator, needle, or seeds into or against the tumour using imaging guidance.
- For high-dose-rate (HDR) brachytherapy, the radioactive source travels through a thin tube into the applicator for a precisely timed period, then is withdrawn automatically. You are not radioactive when you leave.
- For low-dose-rate (LDR) brachytherapy, the implant stays in place for one to several days, and you remain in a shielded hospital room during that time.
- For permanent seed implants, the seeds are left in the body and the applicator needles are removed. The seeds lose their radiation over weeks to months.
- The team takes a check scan to confirm the source is correctly positioned before or after delivery.
- When treatment is complete, the applicator is removed (unless seeds were used), and you are monitored in a recovery area.
Aftercare
Recovery after brachytherapy depends heavily on the type used. HDR patients often go home the same day or the day after their last session, while LDR patients stay in hospital until the implant is removed. Permanent seed patients usually leave within a day but follow specific precautions at home.
- You will be monitored for pain, bleeding, and urinary or bowel function before being discharged.
- Light activity is usually fine within a day or two of an HDR session. Strenuous exercise, heavy lifting, and sexual intercourse are typically restricted for a period your doctor will specify.
- In gynaecological cases, a vaginal dilator (a smooth tube used to gently stretch the vagina) is often prescribed to prevent narrowing of the vaginal canal. Your care team will show you how and how often to use it.
- Wound or insertion site care is usually straightforward: keep the area clean and dry, and watch for signs of infection such as increasing redness, warmth, discharge, or fever.
- If seeds were implanted, you will receive guidance on limiting close contact with pregnant women and young children for a period, since the seeds emit a small amount of radiation while they are still active.
- Follow-up appointments include imaging scans and check-ups to assess how well the tumour has responded to treatment. The schedule is set by your oncologist.
- Fatigue is common in the weeks after treatment. Rest as needed, and a gradual return to normal activity is encouraged over days to weeks.
- Report any new or worsening symptoms, such as blood in urine or stool, severe pelvic pain, or fever, to your care team promptly.
Cost & What Determines It
The cost of brachytherapy varies widely because it depends on the cancer type, the number of sessions, the technology used, and the country and hospital where treatment is delivered.
- Cancer stage and complexity: a single-session HDR procedure for an early-stage cervical cancer costs considerably less than a multi-session plan combined with external beam radiotherapy for a more advanced tumour.
- Treatment type: HDR (high-dose-rate) brachytherapy, LDR (low-dose-rate) brachytherapy, and permanent seed implants each involve different equipment and staffing costs.
- Hospital class and country: a university hospital or internationally accredited cancer centre in a high-income country charges more than a specialist centre in a lower-cost destination.
- Length of stay: LDR brachytherapy requires several inpatient days, adding room, nursing, and monitoring charges that HDR outpatients do not face.
- Applicators, needles, or seeds: these are single-use disposable items, and the cost depends on how many are needed and which type is used.
- Imaging and planning software: the CT or MRI scans used for treatment planning are billed separately in many hospitals.
- Anaesthesia: whether you need sedation, regional anaesthesia, or general anaesthesia affects the total cost.
- Combined treatment: if brachytherapy is paired with external beam radiotherapy or chemotherapy, those treatments are costed separately.
- Post-treatment medications: pain relief, antibiotics, and other supportive drugs add to the total.
Hospital packages often bundle the procedure room, the radioactive source, applicator insertion and removal, and the treatment planning scan into one quoted price. What is typically billed separately includes the pre-treatment diagnostic workup, anaesthesiologist fees, inpatient accommodation beyond the scheduled stay, and follow-up consultations after discharge.
BPJS Kesehatan and most Indonesian private insurance policies do not cover treatment received outside Indonesia, so patients who travel abroad for brachytherapy usually pay out of pocket or through an international private health insurance policy that explicitly includes overseas cancer treatment. Before travelling, ask the hospital for a detailed written cost estimate that lists every expected charge, so there are no surprises on arrival or at discharge.
Frequently Asked Questions
How many brachytherapy sessions will I need?
Most patients need between 3 and 6 sessions, though the exact number depends on your cancer type, its stage, and how your body responds to treatment. Your oncologist (cancer specialist) will plan your course before treatment begins. Sessions are usually spread over several days or weeks to give your body time to recover between each one.
What does brachytherapy feel like during and after a session?
During the procedure you may feel pressure or mild discomfort, particularly in the pelvic area, because small applicators are placed inside or very close to the tumour. Most patients are given local or general anaesthesia (numbing medicine or sleep medicine) to keep them comfortable. Afterwards, some soreness, light bleeding, or a feeling of heaviness in the lower abdomen is common and usually settles within a few days.
How soon will brachytherapy start working?
The radiation from each session begins affecting cancer cells right away, but visible results, such as a shrinking tumour, are usually seen over weeks to months after your full course is complete. Your doctor will schedule follow-up scans to check how well the treatment is working. Response time varies between patients and depends on the size and type of tumour being treated.
How much does brachytherapy cost?
The cost depends on several factors specific to your situation, including the number of sessions prescribed, the type of applicator or radioactive device used, whether you need to stay overnight in hospital, and the class of hospital you choose. Because these variables combine differently for each patient, the only reliable way to get a real number is to request a written estimate directly from the hospital.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
