Update | December 31, 2025 Author : Telma Matos Almeida (Radioncology) High dose rate brachytherapy, or HDR brachytherapy , is a modern modality of internal radiotherapy that allows for the administration of high doses of radiation with extreme precision, directly to the tumor site . It is an innovative approach that enhances tumor control while simultaneously reducing irradiation of adjacent healthy tissues, resulting in lower toxicity and improved quality of life for patients. Thanks to rigorous planning and cutting-edge technology, HDR brachytherapy is now considered a safe, effective, and widely validated therapeutic option based on international scientific evidence. What distinguishes HDR brachytherapy? In HDR brachytherapy, a highly active radioactive source is temporarily introduced into the body through specifically positioned applicators or catheters. The dose distribution is highly conformed to the tumor volume, with radiation administration carefully controlled by computerized remote loading systems. At the end of each session, the source is removed, and no radioactive material remains in the patient's body. This method allows for short-duration treatments, often performed on an outpatient basis or with brief hospital stays, providing greater comfort and convenience. Main clinical indications for HDR brachytherapy High-dose-rate brachytherapy is used in the treatment of various types of tumors and can be applied alone or in combination with other therapies, such as external beam radiotherapy, surgery, or hormone therapy. Prostate cancer In prostate cancer, HDR brachytherapy is an effective therapeutic option in both localized disease and combined treatment regimens. The high precision of the technique allows for the administration of high doses directly to the prostate, preserving critical organs such as the bladder and rectum, with excellent results in terms of local disease control and maintenance of quality of life. It can also be used as salvage therapy in prostate cancer recurrences in patients previously treated with external beam radiotherapy. Endometrial cancer After surgical treatment of endometrial cancer, HDR brachytherapy is frequently used as a complementary treatment, significantly reducing the risk of local recurrence. The technique allows for highly precise treatment of the target area, minimizing side effects. Cervical cancer Brachytherapy is an essential component in the treatment of cervical cancer, being the therapeutic standard in international protocols. The use of the HDR modality, integrated into a multidisciplinary approach, is associated with high rates of local control with a positive impact on the overall survival of patients. Skin cancer In certain skin tumors, HDR brachytherapy is an effective alternative to surgery, especially in lesions located in sensitive anatomical areas or in patients ineligible for surgical treatment. It has excellent aesthetic and functional results, with high local control of the disease. HDR brachytherapy at Hospital da Luz Hospital da Luz stands out as the only in the country to offer high dose rate brachytherapy for the treatment of prostate, endometrial, cervical, and skin tumors. This unique positioning results from a strong investment in cutting-edge technology, specialized training of clinical teams, and practice aligned with the highest international standards. This differentiation allows us to offer personalized, safe treatments based on the best available scientific evidence , reinforcing our unit's role as a national reference center in advanced radiotherapy. Scientific evidence and international recommendations The use of HDR brachytherapy is supported by multiple clinical studies and recommendations from international scientific societies, which recognize its efficacy and safety in the treatment of various gynecological, prostate, and skin tumors. Sources Guinot JL, Rembielak A, Perez-Calatayud J, et al. GEC-ESTRO ACROP recommendations in skin brachytherapy . Radiother Oncol 2018;126:377-85. Haie-Meder C, Pötter R, Van Limbergen E, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV . Radiother Oncol 2005;74:235-45. Hoskin PJ, Colombo A, Henry A, et al. GEC/ESTRO recommendations on high dose rate afterloading brachytherapy for localised prostate cancer: an update . Radiother Oncol 2013;107:325-32. Koh WJ, Abu-Rustum NR, Bean S, et al. Uterine Neoplasms, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology . J Natl Compr Canc Netw 2018;16:170-99. Nag S, Erickson B, Thomadsen B, et al. The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the cervix . Int J Radiat Oncol Biol Phys 2000;48:201-11. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
