# Brachytherapy

Source: https://onco.cc/technologies/brachytherapy/  
OnCo record `brachytherapy` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Brachytherapy places a radioactive source directly inside or next to the tumour.

## Summary

Brachytherapy places sealed radioactive sources (192Ir, 125I, 103Pd) directly inside or next to the tumour, so the dose falls off steeply from within and gives the highest conformality of any radiotherapy technique. It is a mandatory, curative component of cervical cancer treatment, is used in prostate cancer as LDR seed implants or HDR, and is applied in breast (partial-breast), skin, and eye, where plaque brachytherapy treats uveal melanoma. Treatment courses are short compared with external beam. The approach is invasive, requiring an implant procedure, and expertise is declining in some regions even where the evidence is strongest, which is a concern in cervical cancer. The simple version is that the radiation source is put inside the tumour rather than beamed in from outside.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-04
- Principle: Sealed sources (192Ir, 125I, 103Pd) deliver steep dose fall-off from within.
- Strengths: Highest conformality; Short treatment
- Limitations: Invasive; Declining expertise in some regions

## Notes

- Prostate cancer: NICE NG131 (1.3.24) says to consider brachytherapy in combination with external beam radiotherapy for people with CPG 2, 3, 4 and 5 localised or locally advanced disease, and (1.3.25) not to offer brachytherapy alone for CPG 4 and 5. Whether a boost is available is a property of the centre rather than of the guideline, so it is worth asking directly.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Brachytherapy
- Wikipedia: https://en.wikipedia.org/wiki/Brachytherapy
- NICE NG131: prostate cancer, diagnosis and management: https://www.nice.org.uk/guidance/ng131/chapter/Recommendations

## Connected records

- technologies: [High-dose-rate brachytherapy](https://onco.cc/technologies/hdr-brachytherapy/), [Intraoperative radiotherapy (IORT)](https://onco.cc/technologies/intraoperative-radiotherapy/), [Linac, proton system and brachytherapy machine manufacturing](https://onco.cc/technologies/radiotherapy-equipment-manufacturing/), [Low-dose-rate seed brachytherapy](https://onco.cc/technologies/ldr-seed-brachytherapy/), [Remote afterloaders for HDR brachytherapy](https://onco.cc/technologies/brachytherapy-afterloaders/)
- cancers: [Adenosquamous carcinoma of the cervix](https://onco.cc/cancers/cervical-adenosquamous-carcinoma/), [Advanced or recurrent endometrial cancer](https://onco.cc/cancers/advanced-recurrent-endometrial-cancer/), [Biochemical recurrence of prostate cancer](https://onco.cc/cancers/prostate-bcr/), [Cervical cancer](https://onco.cc/cancers/cervical/), [Early cervical cancer and fertility-sparing surgery](https://onco.cc/cancers/early-cervical-cancer/), [Endometrial cancer](https://onco.cc/cancers/endometrial/), [Endometrial cancer with no specific molecular profile](https://onco.cc/cancers/endometrial-nsmp/), [Lip cancer](https://onco.cc/cancers/lip-cancer/), [Localised penile cancer (organ-confined, node-negative)](https://onco.cc/cancers/localised-penile-cancer/), [Localised prostate cancer, high and very high risk](https://onco.cc/cancers/prostate-high-risk/), [Localised prostate cancer, intermediate risk](https://onco.cc/cancers/prostate-intermediate-risk/), [Localised prostate cancer, very low and low risk](https://onco.cc/cancers/prostate-low-risk/), [Locally advanced cervical cancer](https://onco.cc/cancers/locally-advanced-cervical-cancer/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Melanoma](https://onco.cc/cancers/melanoma/), [Mismatch-repair-deficient endometrial cancer](https://onco.cc/cancers/endometrial-mmr-deficient/), [Oesophageal cancer](https://onco.cc/cancers/esophageal/), [p53-abnormal endometrial cancer, including uterine serous carcinoma](https://onco.cc/cancers/endometrial-p53-abnormal/), [Penile cancer](https://onco.cc/cancers/penile/), [POLE-ultramutated endometrial cancer](https://onco.cc/cancers/endometrial-pole-ultramutated/), [Prostate cancer](https://onco.cc/cancers/prostate/), [Retinoblastoma](https://onco.cc/cancers/retinoblastoma/), [Rhabdomyosarcoma](https://onco.cc/cancers/rhabdomyosarcoma/), [Skin cancer (all types)](https://onco.cc/cancers/skin-cancer/), [Soft tissue sarcoma of the extremity (localised and advanced)](https://onco.cc/cancers/extremity-soft-tissue-sarcoma/), [Urethral cancer](https://onco.cc/cancers/urethral/), [Uterine carcinosarcoma](https://onco.cc/cancers/uterine-carcinosarcoma/), [Uveal melanoma](https://onco.cc/cancers/uveal-melanoma/), [Vaginal adenocarcinoma (including DES-associated clear cell adenocarcinoma)](https://onco.cc/cancers/vaginal-adenocarcinoma/), [Vaginal cancer](https://onco.cc/cancers/vaginal/), [Vaginal squamous cell carcinoma (HPV-associated)](https://onco.cc/cancers/vaginal-squamous-cell-carcinoma/)
- fronts: [Radiation Therapy](https://onco.cc/fronts/radiation/)
- companies: [Alpha Tau Medical](https://onco.cc/companies/alpha-tau-medical/), [Eckert & Ziegler](https://onco.cc/companies/eckert-ziegler/), [Elekta](https://onco.cc/companies/elekta/), [Empyrean Medical Systems](https://onco.cc/companies/empyrean-medical-systems/), [GT Medical Technologies](https://onco.cc/companies/gt-medical-technologies/), [Varian (Siemens Healthineers)](https://onco.cc/companies/varian/)
- trials: [ASCENDE-RT](https://onco.cc/trials/ascende-rt/), [INTERLACE](https://onco.cc/trials/interlace/), [KEYNOTE-A18 / ENGOT-cx11 / GOG-3047](https://onco.cc/trials/keynote-a18/), [PORTEC-3](https://onco.cc/trials/portec-3/), [Surgery against radiotherapy for basal cell carcinoma of the face](https://onco.cc/trials/avril-surgery-versus-radiotherapy-bcc/)
- pairings: [Induction chemotherapy → chemoradiation (locally advanced cervical cancer)](https://onco.cc/pairings/induction-chemo-then-crt/), [PD-1 blockade + chemoradiation (locally advanced cervical cancer)](https://onco.cc/pairings/io-plus-crt-cervical/)
- terms: [Bowel cancer after abdominal and pelvic radiotherapy](https://onco.cc/terms/second-primary-bowel-after-abdominal-radiotherapy/), [Brachytherapy (internal radiotherapy)](https://onco.cc/terms/brachytherapy-term/), [Choices made at the time of treatment that change the second cancer risk](https://onco.cc/terms/rejuv-second-choices-made-at-treatment/), [Focal and tissue-preserving treatment of prostate cancer](https://onco.cc/terms/prostate-focal-therapy/), [Palliation in lung cancer: breathlessness, pleural effusion, blocked airway, bone and brain](https://onco.cc/terms/lung-palliation-breathlessness-effusion-obstruction/), [Radiotherapy](https://onco.cc/terms/radiotherapy/), [Radiotherapy and second cancers: field, dose and age at exposure](https://onco.cc/terms/rejuv-second-radiotherapy-dose-field-and-age/), [Radiotherapy for skin cancer](https://onco.cc/terms/radiotherapy-for-skin-cancer/)
- people: [Carien L. Creutzberg](https://onco.cc/people/carien-creutzberg/), [Mary McCormack](https://onco.cc/people/mary-mccormack/)
- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/)
- ideas: [A Global Fund for cancer care in low- and middle-income countries](https://onco.cc/ideas/idea-fund-global-cancer-fund/), [A translation fund for academic surgical devices and radiotherapy technology](https://onco.cc/ideas/idea-fund-device-and-technique-translation-fund/), [Blended finance and a low-cost linac to close the global radiotherapy gap](https://onco.cc/ideas/idea-fund-lmic-radiotherapy-finance/), [Low-cost cobalt-60 brachytherapy for cervical cancer in every regional centre](https://onco.cc/ideas/idea-acc-frugal-hdr-brachytherapy/), [Radiotherapy for everyone who needs it by 2040](https://onco.cc/ideas/idea-moon-radiotherapy-for-everyone-2040/)
- key papers: [KEYNOTE-A18: pembrolizumab with chemoradiotherapy for locally advanced cervical cancer (overall survival)](https://onco.cc/key-papers/paper-keynote-a18-os-lancet-2024/), [KEYNOTE-A18: pembrolizumab with chemoradiotherapy for locally advanced cervical cancer (progression-free survival)](https://onco.cc/key-papers/paper-keynote-a18-pfs-lancet-2024/)
- institutions: [American Society for Radiation Oncology](https://onco.cc/institutions/astro/), [Cancer Institute (WIA), Adyar](https://onco.cc/institutions/cancer-institute-adyar/), [Centre Oscar Lambret](https://onco.cc/institutions/centre-oscar-lambret/), [Dharmais National Cancer Center](https://onco.cc/institutions/dharmais-cancer-hospital/), [European Society for Radiotherapy and Oncology](https://onco.cc/institutions/estro/), [European Society of Gynaecological Oncology](https://onco.cc/institutions/esgo/), [Groote Schuur Hospital / University of Cape Town](https://onco.cc/institutions/groote-schuur-uct/), [Hacettepe University Cancer Institute](https://onco.cc/institutions/hacettepe-cancer-institute/), [Ho Chi Minh City Oncology Hospital](https://onco.cc/institutions/hcmc-oncology-hospital/), [Institut Bergonié](https://onco.cc/institutions/institut-bergonie/), [Institut National d'Oncologie, Rabat](https://onco.cc/institutions/institut-national-oncologie-rabat/), [Institut Salah Azaïez](https://onco.cc/institutions/institut-salah-azaiez/), [Institute of Oncology Ljubljana](https://onco.cc/institutions/onkoloski-institut-ljubljana/), [Instituto Nacional de Cancerología (Colombia)](https://onco.cc/institutions/inc-colombia/), [Instituto Nacional de Cancerología (Mexico)](https://onco.cc/institutions/incan-mexico/), [Instituto Nacional de Enfermedades Neoplásicas](https://onco.cc/institutions/inen-peru/), [Instituto Português de Oncologia do Porto Francisco Gentil](https://onco.cc/institutions/ipo-porto/), [International Atomic Energy Agency: Rays of Hope](https://onco.cc/institutions/iaea/), [Istanbul University Institute of Oncology](https://onco.cc/institutions/istanbul-oncology-institute/), [Kenyatta National Hospital](https://onco.cc/institutions/kenyatta-national-hospital/), [Koo Foundation Sun Yat-Sen Cancer Center](https://onco.cc/institutions/koo-foundation-sun-yat-sen-cancer-center/), [Korle Bu Teaching Hospital](https://onco.cc/institutions/korle-bu-teaching-hospital/), [Lagos University Teaching Hospital](https://onco.cc/institutions/luth-lagos/), [Maria Skłodowska-Curie National Research Institute of Oncology](https://onco.cc/institutions/nio-warsaw/), [Masaryk Memorial Cancer Institute](https://onco.cc/institutions/mou-brno/), [Mount Vernon Cancer Centre](https://onco.cc/institutions/mount-vernon-cancer-centre/), [National Institute of Oncology, Hungary](https://onco.cc/institutions/noi-budapest/), [Ocean Road Cancer Institute](https://onco.cc/institutions/ocean-road-cancer-institute/), [Postgraduate Institute of Medical Education and Research, Chandigarh](https://onco.cc/institutions/pgimer-chandigarh/), [Sunnybrook Odette Cancer Centre](https://onco.cc/institutions/sunnybrook-odette/), [Uganda Cancer Institute](https://onco.cc/institutions/uganda-cancer-institute/), [Velindre Cancer Centre](https://onco.cc/institutions/velindre-cardiff/)
- roadmaps: [Devices and physical therapies roadmap: heat and light → electric fields and focused sound → drug-releasing implants](https://onco.cc/roadmaps/devices-roadmap/), [Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH](https://onco.cc/roadmaps/radiation-roadmap/)

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