ENBrachytherapy in Germany irradiates a tumour from inside: instead of a beam crossing healthy tissue from outside, the source sits in the tumour or right against it. So the high dose stays where it is needed and falls away sharply within a centimetre or two.
This page explains which tumours it treats, how the two variants differ, what happens on the day and afterwards, and what to ask, since it is not offered everywhere or suitable for everyone. See also cancer treatment in Germany.
How brachytherapy works
Brachytherapy is temporary or permanent. In temporary high-dose-rate (HDR) treatment, hollow needles, catheters or an applicator are placed under ultrasound or CT guidance and an afterloader sends the source in for a few minutes; then everything comes out, leaving nothing behind. In permanent low-dose-rate (LDR) treatment, rice-sized isotope seeds stay in the tissue, releasing their dose over months as they decay.
Beforehand the needles or applicator are imaged by ultrasound, CT or MRI, and a medical physicist and radiation oncologist calculate where and how long the source stops, or where seeds go. That plan is the core of treatment: the dose drops steeply, so it decides whether the tumour edge gets enough and what nearby organs receive.
Implantation is done under spinal or brief general anaesthesia and takes about one to two hours in the prostate; a bladder catheter usually comes out afterwards unless the gland swells. Most patients stay a day or two. HDR may need several sessions, days to a week apart; the German Cancer Research Center’s Krebsinformationsdienst explains radiotherapy in detail.
Brachytherapy for prostate cancer
Brachytherapy for prostate cancer is mainly offered when the tumour is confined to the gland. Under the current German S3 guideline, seeds alone are an option for low and favourable intermediate risk, although active surveillance is standard for low risk; in higher risk, brachytherapy only boosts external beam radiation. A tumour board decides on stage, ISUP grade group, PSA and gland volume, not preference alone (see prostate cancer treatment in Germany).
In the first weeks urination is often painful, especially at night. Seeds emit little radiation, but for some weeks men avoid holding small children on their lap and keep their distance from pregnant women, as the department instructs. Erections may weaken years later, which can usually be treated with medication. MRI is still possible, though seeds can distort parts of the images.
For a real answer, send the histology with ISUP grade group, PSA trend, prostate MRI, any PSMA PET-CT, uroflowmetry with residual urine and past prostate operations. A large gland or marked difficulty passing urine can rule the method out; after a TURP (prostate surgery through the urethra) it remains possible if the defect is small and time has passed.
Which other tumours it is used for
Brachytherapy has long been used for cervical and womb cancer. In cervical cancer treated with chemoradiotherapy it routinely follows external radiation, through an applicator inserted into the vagina and cervix under a short anaesthetic. Precision matters because the bladder and rectum lie close, so the S3 guideline recommends MRI-based planning. In womb cancer the vagina is usually treated from inside after surgery, to lower the risk of local recurrence.
Selected centres also treat skin and some head and neck tumours, and for oesophageal cancer the S3 guideline recommends offering it to ease swallowing. For a tumour narrowing a bronchus, it is offered only in individual cases to reopen the airway. In low-risk breast cancer, the tumour bed alone may be treated, externally or through several brachytherapy catheters. Indications vary between hospitals: ask first.
How it differs from external beam radiation
Brachytherapy irradiates from inside rather than through skin and surrounding tissue. The course is usually shorter, one implant or a few sessions instead of weeks of daily visits. In prostate cancer it allows a higher dose while sparing the rectum and bladder. It needs a procedure under anaesthesia, and needles or an applicator must reach the tumour. «Better» means nothing without a specific tumour, and the methods often complement each other; see radiotherapy for prostate cancer in Germany.
Cost depends on the number of sessions, source type, anaesthesia and hospital days, plus any external radiation; the hospital’s written estimate gives the figure. For the bill’s components, see radiation therapy in Germany.
Where it is done and what to ask
Not every radiation oncology department offers brachytherapy; the partners below are examples, not a ranking. The Department of Radiotherapy at University Hospital Augsburg, headed by Professor Georg Stüben, treats tumours of the uterus, vagina, oesophagus, airways, ENT region and skin with an afterloader. Dr Peter Stoll’s radiotherapy practice in Munich’s Pasing district uses external beams; brachytherapy is not among its methods. So confirm the methods for each diagnosis.
A second opinion from a German doctor on your records shows before travelling whether the method fits. Ask the department:
- is it done here for my diagnosis;
- HDR or seeds, and why;
- how many sessions, what anaesthesia;
- how many days in Germany;
- who follows me up at home, with which checks.
Frequently asked questions
Is brachytherapy painful?
Usually not: prostate needles and catheters go in under spinal or general anaesthesia, a gynaecological applicator under a short anaesthetic, and the irradiation itself is not felt. Discomfort can follow, such as painful urination after prostate brachytherapy; ask how it will be eased.
Is a patient a risk to others after brachytherapy?
After temporary brachytherapy, as a rule, no: the source is removed. Seeds stay inside and emit weak radiation, so close contact with pregnant women and small children is avoided for a while; the doctor explains which precautions apply and how long, ideally in writing.
What side effects can brachytherapy cause?
They depend on the organ treated and mostly affect nearby tissue: bladder, urethra and sometimes rectum after prostate brachytherapy, the vaginal lining after gynaecological treatment, where narrowing or adhesions can develop. Most acute complaints settle, but late effects are possible, especially combined with external radiation.
How AlenMed organises treatment
After first contact, a medical interpreter translates records, histology and images for two or three radiation oncology departments. They reply whether brachytherapy fits, what else is proposed if not, and in what order; medical visa paperwork runs alongside.
AlenMed works with 86 partner hospitals in 38 German cities and 345 doctors; the company office is in Munich. A coordinator books the consultation, interprets, helps with accommodation between sessions and collects the discharge letter with the follow-up plan.
This material is for information only, not an offer; treatment is decided by a doctor in person.
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