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Brachytherapy in India Brachytherapy involves placing a radioactive material directly inside or next to the tumor. “Brachy” is Greek word meaning short. Brachytherapy allows use of a high dose of radiation while reducing the risk of damage to nearby healthy tissue and increasing the likelihood the cancer is destroyed. Doctors may place Brachytherapy seeds inside a body cavity, such as the vagina, or insert seeds into body tissue using hollow needles. Brachytherapy may be used alone or with radiation given externally. Radioactive seeds may be left permanently in place or removed after some time.
Brachytherapy History In 1901, Pierre Curie suggested to Danlos at St. Louis Hospital in Paris that a small radium tube be inserted into a tumor thus heralding the birth of Brachytherapy. In 1903, Alexander Graham Bell made a similar suggestion, completely independently, in a letter to the Editor of Archives Roentgen Ray. It was found in these early experiences that inserting radioactive materials into tumors revealed that radiation caused cancers to shrink. In the early twentieth century, major Brachytherapy work was done at the Curie Institute in Paris and at Memorial Hospital in New York. Dr. Robert Abbe, the chief surgeon at St. Lukes Hospital of New York, placed tubes into tumor beds after resection, and later inserted removable Radium sources thus introducing the after loading technique as early as 1905. Dr. William Myers at Ohio State University developed several radioisotopes, including Gold-198, Cobalt-60, Iodine-125, and Phosphorus-32 for clinical Brachytherapy. These were implanted surgically by Drs. Arthur James (surgeon) and Ulrich Henschke (radiation oncologist). Finally, while Brachytherapy was initially used only for treatment of cancer, it has now been found to be useful in nonmalignant diseases (for example, in the prevention of vascular rest enosis) as well. It is clear that Brachytherapy is the optimum way of delivering conformal radiotherapy tailored to the shape of the tumor while sparing surrounding normal tissues.
Conditions Treated with Brachytherapy Brachytherapy is used to treat cancers throughout the body, including the: • • • • • • • • • •
Prostate Cancer Head and Neck Cancer Skin Cancer Breast Cancer Gallbladder Carcinoma Uterine Carcinoma Vaginal Cancer Lung Cancer Rectum Cancer Eye Cancer
Brachytherapy is an effective option for some people who have prostate cancer or cervical cancer, and may be preferred for some women who have uterine (endometrial) cancer. Doctors recommend Brachytherapy for people who are at risk for tumor re-growth in the upper vagina after removal of the uterus.
Success Rate of Brachytherapy The results of prostate Brachytherapy are comparable to those of radical prostatectomy for five to seven years after treatment. The long-term data (longer than 10 years after treatment) are limited. Studies demonstrate success rates of 74% at seven years, with success being defined by either a PSA of less than 0.5ng/ml or the absence of three consecutive rises in PSA in patients who received Brachytherapy and external beam radiation therapy (EBRT). Survival rates for men who receive this procedure are from 81% to 93%. Given the aggressiveness of most cancers, especially if not treated early, this is a very high success rate. Preparation for Brachytherapy Doctor will determine which preparations need to be done prior to your Brachytherapy procedure. These may include: • • • • •
Bowel preparation Pre-treatment ultrasound, MRI or CT scan Blood tests Electrocardiogram (EKG) Chest X-rays
Doctor may also use computer programs to plan the Brachytherapy before the actual treatment procedure. A few days before procedure, you will be given specific instructions on how to prepare for your Brachytherapy procedure.
Brachytherapy Types Different types of Brachytherapy can be defined according to the source placement, dose rate and dose delivery time.
Source placement The two main types of Brachytherapy treatment in terms of the placement of the radioactive source are interstitial and contact. • •
In the case of interstitial Brachytherapy, the sources are placed directly in the target tissue of the affected site, such as the prostate or breast. Contact Brachytherapy involves placement of the radiation source in a space next to the target tissue.
Dose rate The dose rate of Brachytherapy refers to the level or ‘intensity’ with which the radiation is delivered to the surrounding medium and is expressed in Grays per hour (Gy/h). •
Low-dose rate (LDR), Brachytherapy involves implanting radiation sources that emit radiation at a rate of up to 2 Gy.hr-1.[ LDR Brachytherapy is commonly used for cancers of the oral cavity, oropharynx, sarcomas and prostate cancer Medium-dose rate (MDR), Brachytherapy is characterized by a medium rate of dose delivery, ranging between 2 Gy.hr-1 to 12 Gy.hr-1. High-dose rate (HDR), Brachytherapy is when the rate of dose delivery exceeds 12 Gy.hr-1. The most common applications of HDR Brachytherapy are in tumors of the cervix, esophagus, lungs, breasts and prostate. Most HDR treatments are performed on an outpatient basis, but this is dependent on the treatment site.
Pulsed-dose rate (PDR), Brachytherapy involves short pulses of radiation, typically once an hour, to simulate the overall rate and effectiveness of LDR treatment. Typical tumor sites treated by PDR Brachytherapy are gynecological and head and neck cancers.
Duration of dose delivery The placement of radiation sources in the target area can be temporary or permanent. •
Temporary Brachytherapy involves placement of radiation sources for a set duration (usually a number of minutes or hours) before being withdrawn. The specific treatment duration will depend on many different factors, including the required rate of dose delivery and the type, size and location of the cancer. In LDR and PDR Brachytherapy, the source typically stays in place up to 24 hours before being removed, while in HDR Brachytherapy this time is typically a few minutes.
Permanent Brachytherapy, also known as seed implantation, involves placing small LDR radioactive seeds or pellets (about the size of a grain of rice) in the tumor or treatment site and leaving them there permanently to gradually decay. Over a period of weeks or months, the level of radiation emitted by the sources will decline to almost zero. The inactive seeds then remain in the treatment site with no lasting effect. Permanent Brachytherapy is most commonly used in the treatment of prostate cancer.
Brachytherapy Procedure site In Brachytherapy procedure physicians place the source of irradiation close to the tumor or within a body cavity. Brachytherapy may include placing radioactive sources inside a body cavity such as the vagina, or by putting radioactive material directly into body tissue using hollow needles. Brachytherapy may be given in addition to external beam radiation, or it may be used as the only form of radiotherapy. In some cases the radioactive sources may be permanently left in place; in other cases, they are removed after a specified time. Placement of radioactive sources may be repeated several times in some situations. Brachytherapy Advantages Advantages of Brachytherapy include: •
The precise targeting of the radiation, which spares healthy tissue;
The fact that the procedure can usually be completed in 1-3 hours on an outpatient basis;
A substantially lower incidence than surgery or external beam irradiation of both impotence and incontinence; and little to no impact on the patient's quality of life.
Patients typically return to their normal activities within 1-2 days with minimal restrictions.
Brachytherapy greatly shortens the duration of the treatment, in fact prostate cancer Brachytherapy can often take one and a half days rather than the 5-7 weeks of traditional radiation.
Risks of Brachytherapy Risks of this treatment approach include some incidence of impotence and incontinence, frequent urination and, occasionally, blood in the urine.
Alternative to Brachytherapy There are other alternative to Brachytherapy which can be either radiotherapy like external beam radiation or surgical. External beam radiation therapy (EBRT) is the use of radiation therapy to kill or inactivate cancer cells. Radiation is given in separate, smaller doses known as fractionation.
Brachytherapy in India There are many advantages of Brachytherapy in India. Some of them are: •
International accredited partner hospitals, patient centered approach with well equipped facilities. English speaking staff, providing personalized and caring service at par with any best hospital in the world.
Extensive investments have been made to ensure that all medical centers are equipped with modern facilities, internationally accredited hospitals of India are capable of handling the latest techniques and procedures. These state-of-the-art facilities focus on what matters: more effective, efficient and pleasant solutions for patients.
With all medical centers equipped with modern facilities, medical centers in India are able to provide shorter waiting time. Patients may be hospitalized upon arrival, and examinations and work-up tests are usually addressed promptly.
The Indian government has made it easier for visitors seeking health treatments to enter the country. With the relevant letter from the medical centre at which you will be receiving your medical treatment, you may enjoy up to six months of visa extension.
Brachytherapy Cost in India •
India offers a low cost brachytherapy for international patients.
India's favorable exchange rate and the cost of healthcare services are at an extensively lower cost than that of other countries. If you're coming from a Western country such as the United States or Britain, medical procedures in India will generally cost a fraction of the price as compared to prices back home.
Prices in India are reasonable and affordable, be it accommodation, food or even shopping.
From comfortable and affordable hotels to five-star accommodations, India provides you with a choice to budget or splurge. Hotels start from as low as USD50 to USD150 per night depending on its star rating. Alternatively, if your family is accompanying you for treatment, there is also an option to rent a serviced apartment.
Brachytherapy in India offered by Indian Medguru Group Indian Medguru Group the top most medical tourism company in India having all the top most hospitals in its panel delivering best medical services to the patients. You just have to send us a query regarding brachytherapy in India and within 24 hours, a patient coordinator will contact you for further details and interaction. From that point everything will be taken care of by that coordinator, like arranging VISA, accommodation, appointment with the doctor with round the clock services to make your medical tour hassle free. Indian Medguru Group offers well-qualified and professional doctors, surgeons, physicians, and medical staff who aid you in recovery from your ailment and ensure a safe and healthy journey back home.
Brachytherapy in India is available in following cities;
Some of the common countries from which patients travel to India for surgery are:
ABOUT INDIA Located in South Asia, bordered by Pakistan, Nepal, China and Bangladesh, India is South Asia's largest, sovereign, democratic republic. India has an edge over other countries when it comes to offering comprehensive, cost-effective and timely medical care: it also offers an exotic, adventure-filled or cultural -if you wish array of destinations to discover and revel in for the travelers. Indian cities like Mumbai, Hyderabad, Goa, Bangalore, Nagpur, Kerala, Delhi, Pune, Jaipur, Chennai, Gurgaon, and Chandigarh offers best medical tourism service. Mumbai - Formerly known as Bombay, is the commercial & financial capital city of India. Mumbai is famous for many things, including its thriving Bollywood film industry, teeming bazaars, colonial-style buildings, Art Deco structures and a superb choice of restaurants, often being rated as the dining capital of India. The tourist district of Colaba in Mumbai is a great place to start exploring this great city. Hyderabad – Hyderabad city is a great place to visit in the state of Andhra Pradesh. The place has witnessed a continuous growth for last many years. Hyderabad has become a tourist hotspot following ever increasing number of tourists during past few years. Hyderabad has a well-founded reputation as one of the safest cities in the world. Goa - The country's smallest state and famed for its colonial Portuguese and Catholic past, most tourists visit Goa for its endless selection of sandy beaches and coastal attractions. Standing proudly next to the Arabian Sea, Goa is a particularly compact state and often feels like a large town, being easy to travel. Around Goa, tourists will soon realize that the state has much more to offer than simply stunning beaches, fishing, water scooters, windsurfing and scuba diving. Bangalore - Beauty lies in the eyes of beholder and if you want to see one of the most beautiful places in India then Bangalore is the word for it. Bangalore has earned sobriquets like 'Silicon Valley of India', 'Pub Capital of India', and 'City of Gardens'. Pleasant climate with colorful gardens with lakes and glittering nightlife, Bangalore has made its own attraction for travelers as one of the most charming cities in India, Nagpur - Nagpur is the largest city in central India, but with its friendly atmosphere and dependable transportation, you’ll instantly feel at home. The city of Nagpur has a well-built infrastructure, is a clean and affluent city which makes a good jumping-off point for a series of trips into the far eastern corner of Maharashtra. Kerala - Natural beauty, clean air and primordial greenery amidst the vast expanse of water and sky, typifies the state of Kerala – better known as God's own country. Kerala is famous for its alternative medical therapies such as Ayurveda, which help to rejuvenate and revitalize the body. The region is also home to India’s only virgin tropical rain forest – the Silent Valley National Park, supporting an overwhelming range of life forms, many of which are highly endangered, and endemic to this part of the planet. Delhi - "Welcome to The Capital City of India - New Delhi" Delhi is famous as Capital city of India is located in North India. Delhi is truly a symbol of the old and the new; a blend of ancient well preserved monuments and temples along with jampacked burger joints and up market shopping malls. Delhi has state of the art Hospitals and the best qualified doctors. Pune - Once referred to as the Oxford of the east, Pune continues to be a stronghold for academics and culture. An array of factors like availability of efficient and experienced doctors, comparatively low treatment costs, hospital facilities of international standards and many more have made Pune one of the top destinations for medical tourism. Jaipur - Jaipur is one of the most popular destinations on a tourist's itinerary. The magnificent forts, beautiful havelis and colourful bazaars make Jaipur a popular tourist destination among tourists. Jaipur has pioneered health and medical tourism in India. Chennai - Chennai is one of the most developed urban centers in the Indian subcontinent. The city forms the capital of Tamil Nadu state and is the fourth largest metropolitan city in India. They have some of the very best hospitals and treatment centers in the world. Each hospital is equipped with state of the art facilities. The technology brought into practice is the very latest, including robotic surgery.
Knee Replacement Surgery in India Knee replacement surgery also known as knee arthroplasty is procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. The procedure has been proven to help individuals return back to moderately challenging activities such as golf, bicycling, and swimming. Total knees are not designed for jogging, or sports like tennis and skiing (although there certainly are people with total knee replacements that participate in such sports). Knee replacement is a routine surgery performed on over 600,000 people worldwide each year. Over 90% of people who have had Total Knee Replacement experience an improvement in knee pain and function.
Knee Replacement Surgery Candidates A person would be considered a candidate for knee replacement if there is: • • • • • •
Daily pain The pain is severe enough to restrict work, recreation and ordinary activities of daily living Significant stiffness in the knee Significant instability (constant giving way) of the knee Significant deformity (knock-knees or bow-legs) that hinders normal function of the knee Damage from arthritic conditions, such as osteoarthritis, rheumatoid arthritis or post-traumatic arthritis
Success Rate of Knee Replacement Surgery: Knee replacement surgery is recognized as a miracle of modern surgery. Most orthopedic experts consider replacement to be the best method of handling arthritis in the knee. Knee replacements have literally put hundreds of thousands of Americans back on their feet and allowed them to enjoy their golden years.
Knee Replacement Surgery Preparations: • • • •
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If you smoke, cut down or quit. Smoking changes blood flow patterns, delays healing and slows recovery. If you drink, don't have any alcohol for at least 48 hours before surgery. Ask your doctor for pre-surgical exercises. If you are having hip or knee replacement surgery, doing exercises to strengthen your upper body will help you cope with crutches or a walker after surgery. Your primary care physician or an internist will conduct a general medical evaluation several weeks before surgery. This examination will assess your health and your risk for anesthesia. The results of this examination should be forwarded to your orthopaedic surgeon, along with a surgical clearance. Shortly before your scheduled surgery, you will probably have an orthopedic examination to review the procedure and answer any last-minute questions. You may need to take several types of tests, including blood tests, a cardiogram, a urine sample and a chest X-ray. Advice your surgeon of any medical conditions you have and of all the medications you are taking. You may need to stop taking certain medications or your surgeon may recommend substitute medications until your surgery. Medications such as corticosteroids, insulin or anti-coagulants will need to be managed before and after surgery.