Brachytherapy for Head And Neck Cancer: Types, Success Rate, Side Effects And More

Brachytherapy for Head and Neck Cancer is a type of internal radiation therapy where radioactive sources are placed directly into or near the tumor site. This highly targeted approach delivers concentrated radiation to the cancer while limiting exposure to surrounding healthy tissues such as the salivary glands, oral cavity, and spinal cord. It is typically used for selected cases of localized head and neck cancers, such as early-stage oral cavity cancers or recurrent tumors, and may be offered alone or in combination with external beam radiation therapy (EBRT) depending on the tumor location, size, and prior treatments.

The procedure is usually performed under anesthesia, and patients may require a short hospital stay. It is generally well tolerated, with side effects including localized pain, mucositis, difficulty swallowing, or temporary changes in speech or taste. These effects are usually manageable and tend to improve with time and supportive care.

Types of Brachytherapy for Head & Neck Cancer

Brachytherapy is a highly effective form of internal radiation therapy for selected cases of head and neck cancer, particularly for patients with early-stage or recurrent tumors in areas such as the oral cavity, oropharynx, or nasopharynx. It involves placing radioactive sources directly into or near the tumor site, allowing for the delivery of a high and precise dose of radiation while minimizing exposure to surrounding healthy structures like the salivary glands, mandible, and spinal cord.

This targeted approach helps reduce side effects and better preserve functions such as speech, swallowing, and taste. Brachytherapy offers excellent local tumor control and is often chosen when preserving anatomical structures and quality of life is a key priority. In many cases, it provides comparable or superior outcomes to external beam radiation therapy (EBRT) or surgery, especially in recurrent disease or when prior treatments limit further external radiation.

The procedure is typically performed under anesthesia, with a brief hospital stay depending on the technique used (high-dose-rate or low-dose-rate brachytherapy). Recovery is generally quicker than with extensive surgery, and the minimally invasive nature of the treatment makes it a valuable option for patients seeking effective tumor control with a focus on functional preservation. Clinical evidence supports brachytherapy’s role in providing durable disease control with a favorable safety profile, particularly in well-selected patients.

How Effective Is Brachytherapy For Head & Neck Cancer?

Brachytherapy has emerged as a highly effective treatment option for selected head and neck cancers, particularly in early-stage or recurrent disease, offering excellent local control with preservation of function and quality of life.

High Local Control Rates

Clinical studies have shown strong local tumor control with brachytherapy in head and neck cancers. For instance, in early-stage oral cavity cancers, 5-year local control rates can exceed 85%, especially when brachytherapy is used as a boost after surgery or external beam radiation.

Effective Salvage Treatment

In patients with recurrent disease previously treated with radiation, brachytherapy has been successfully used as a salvage therapy, providing disease control with limited additional toxicity. A study in Radiotherapy and Oncology (2022) demonstrated a 2-year local control rate of over 70% in recurrent oral cavity cancers treated with high-dose-rate (HDR) brachytherapy.

Functional Preservation

Brachytherapy allows precise radiation delivery to the tumor bed while sparing critical structures like the mandible, salivary glands, and spinal cord—helping maintain speech, swallowing, and appearance. Median dose to surrounding tissues is significantly lower compared to external modalities.

Advantages Over Other Treatments

The highly localized nature of brachytherapy reduces radiation exposure to healthy tissue, limiting complications such as xerostomia, mucositis, or osteoradionecrosis, which are more common with extensive external beam radiation. HDR brachytherapy can be completed in a few sessions over several days, unlike EBRT which typically requires 6–7 weeks of daily treatment. This makes it a time-efficient option, especially for outpatient settings or in resource-limited environments.

By minimizing treatment duration, hospital stay, and long-term side effect management, brachytherapy may be a more cost-effective option for selected patients, especially in salvage scenarios where other treatments are more invasive or carry higher risks.

The Procedure and Preparation Steps for Brachytherapy in Head & Neck Cancer Treatment

Before head and neck cancer brachytherapy, doctors use advanced imaging techniques such as CT, MRI, or ultrasound to accurately map the tumor’s size, shape, and location, as well as its proximity to critical structures like the mandible, salivary glands, and spinal cord. This imaging is essential for creating a customized treatment plan that ensures precise placement of the radioactive sources and delivers the optimal radiation dose while sparing surrounding healthy tissues.
The medical team provides a detailed explanation of the procedure, answers any questions, and discusses what to expect during and after treatment. This includes information about the type of brachytherapy (High-Dose-Rate or Low-Dose-Rate), whether the radiation source will be temporary or permanent, and potential side effects.

During the procedure, catheters, needles, or applicators are inserted into or around the tumor bed, often guided by real-time imaging or surgical planning.

• In High-Dose-Rate (HDR) brachytherapy, a radioactive source is temporarily placed into the applicators for a short period—typically minutes—then removed. The procedure is usually performed under general or local anesthesia and may be completed in one to several sessions over a few days. Many patients are treated on an outpatient basis or with a short hospital stay.
• In Low-Dose-Rate (LDR) brachytherapy, which is less common for head and neck cancers, radioactive seeds may be implanted permanently to deliver radiation over time. This approach may be used in select cases, such as early oral cavity cancers or certain palliative settings.

After the procedure, patients are closely monitored for side effects and recovery. Most side effects are manageable and may include localized pain, temporary swelling, mucositis, or difficulty swallowing or speaking. These typically resolve over time with supportive care. Fatigue may occur but is usually short-termю

Follow-up appointments are scheduled to monitor treatment effectiveness, manage any late effects, and ensure proper healing. Additional imaging or endoscopic evaluations may be performed to assess response. Head and neck brachytherapy offers a highly targeted and organ-preserving treatment option, particularly valuable for patients with localized or recurrent tumors where precision and function preservation are priorities. It aims to maximize tumor control while maintaining quality of life.

Brachytherapy Side Effects: What Should You Expect?

Brachytherapy is a highly effective treatment for selected head and neck cancers, offering excellent local tumor control with a focused delivery of radiation directly to the tumor site. Because the radiation is confined to a small area, damage to surrounding healthy tissues such as the salivary glands, jawbone, or spinal cord is minimized. Most patients tolerate the procedure well, but as with any treatment, brachytherapy may cause side effects, which are usually mild to moderate in severity.

Short-term side effects typically develop within the first few weeks after treatment and gradually improve. These may include localized pain or swelling, mucositis (inflammation of the mouth or throat lining), difficulty swallowing (dysphagia), or hoarseness, depending on the tumor’s location. Mild skin irritation or tenderness at the treatment site is also possible. Patients may experience fatigue, especially after multiple high-dose-rate (HDR) brachytherapy sessions.

To help manage these symptoms, supportive care measures may include pain relievers, mouth rinses to reduce inflammation, and nutritional support if eating becomes difficult. Patients are also advised to maintain good oral hygiene and avoid tobacco or alcohol during recovery, as these can worsen irritation and delay healing.

Long-term side effects are less common but can include persistent dry mouth (xerostomia), fibrosis (tissue scarring), difficulty with speech or swallowing, or, in rare cases, damage to nearby bone or soft tissue. The risk of long-term complications is reduced through precise treatment planning and advanced imaging techniques that protect critical structures. Most patients experience gradual improvement in function and quality of life over the months following treatment. Regular follow-up visits are essential to monitor treatment response, evaluate for any late effects, and ensure early detection of any recurrence.

How Long Does It Take to See Results?

The timeline for seeing results from head and neck cancer brachytherapy can vary based on the tumor type, location, and whether the treatment is given alone or as part of a combined approach with surgery or external beam radiation therapy. Unlike treatments that may show immediate physical changes, the effects of brachytherapy develop gradually as the radiation continues to act on cancer cells over time.

Tumor response is typically assessed using a combination of clinical examination, imaging (such as MRI, CT, or PET scans), and endoscopic evaluations. In the weeks and months after treatment, gradual tumor shrinkage and healing of the treated area are expected. It may take several months to see the full effect of brachytherapy, and follow-up imaging is usually performed around 8 to 12 weeks post-treatment to assess response.

In terms of symptom relief, patients may start to notice improvements in pain, swallowing, or speech function within a few weeks after treatment, particularly as inflammation subsides. However, it’s not uncommon to experience temporary symptoms such as mucositis, local swelling, or mild discomfort during the early post-treatment period before improvement occurs.

For most patients with localized or recurrent head and neck cancers, brachytherapy offers excellent local control. Treatment success is monitored through regular follow-up visits that include clinical evaluation and imaging. These appointments are crucial to ensure the cancer is responding well and to manage any side effects that might develop over time.

Ongoing communication with the care team is important, especially if there are new symptoms or changes in function, such as speech or swallowing difficulties. With its high precision, tissue-sparing technique, and durable results, brachytherapy remains a valuable treatment option for selected patients with head and neck cancer.

How Much Does Brachytherapy Cost?

The cost of brachytherapy for head and neck cancer can vary widely depending on several factors, including the type of brachytherapy used (such as high-dose-rate or interstitial implantation), the tumor location, the complexity of the procedure, geographic region, and whether care is provided in a public or private healthcare facility.

In the United States, the total cost of head and neck brachytherapy can range from $15,000 to $50,000 or more. This estimate typically includes the treatment planning process (which may involve CT, MRI, or PET scans), anesthesia, the procedure itself, inpatient or outpatient care, and follow-up appointments. Costs may be higher when brachytherapy is combined with other modalities like external beam radiation therapy (EBRT), chemotherapy, or surgery.

In Europe, costs tend to be lower, generally ranging from €7,000 to €25,000, depending on the country and whether the treatment is performed in a public or private institution. In countries with universal healthcare systems, such as France, Germany, or the UK, much of the cost may be covered by national health insurance programs, significantly reducing or even eliminating out-of-pocket expenses for eligible patients.

In countries like India, Thailand, and other parts of Southeast Asia, the cost of brachytherapy for head and neck cancer is typically more affordable, often falling in the range of $4,000 to $10,000. These lower prices, combined with high-quality care in select hospitals, have made such destinations popular for international patients seeking cost-effective cancer treatment.

Additional expenses can include diagnostic tests, medications for managing side effects (such as pain or inflammation), nutritional support, and post-treatment rehabilitation services, particularly for speech and swallowing function. Health insurance may cover a significant portion of the expenses, especially when brachytherapy is considered a standard or recommended treatment.

How Does Brachytherapy Compare to Other Treatments for Head and Neck Cancer?

The choice between brachytherapy and other treatments for head and neck cancers depends on multiple factors, including tumor size, location, the patient’s preferences regarding treatment invasiveness, and the likelihood of achieving long-term tumor control. Brachytherapy is an attractive option for patients with small, localized tumors, as it can provide excellent local control with a relatively quick recovery time compared to surgery and EBRT. However, each treatment option has its unique set of short-term and long-term side effects that should be carefully considered.

A scoping review by Mae Cua et al., published in the Journal of Contemporary Brachytherapy in 2024, explored the evolution of head and neck (HN) brachytherapy since 2017 GEC-ESTRO guidelines. The systematic search yielded 215 unique articles, with 132 primary studies included (112 clinical, 22 simulation/dosimetric). China produced the most research. Oral cavity (n=84), oropharynx (n=37), and salivary glands (n=20) were the most studied sites.

High-dose-rate brachytherapy was most reported (n=57), but studies on low-dose-rate permanent seed implants showed resurgence (n=50), often with CT (n=50) and template (n=27) guidance. Emerging trends included application in other HN sites, LDR seed implants, perioperative brachytherapy (n=18), and 3D printing for template design (n=11). The review concludes these trends provide a foundation for future guidelines.

Brachytherapy vs. Surgery (Surgical Resection)

In the context of head and neck cancers, surgical resection involves the removal of tumors along with surrounding tissues, and it’s often recommended for patients with localized, resectable tumors. Surgery may be considered the standard treatment for certain cancers like oral cavity or laryngeal carcinoma. Brachytherapy, on the other hand, is less invasive and involves placing radioactive sources directly into or near the tumor, providing a localized dose of radiation. While surgery may offer immediate tumor control and is curative for many early-stage cancers, it may lead to functional challenges, such as swallowing difficulties, speech impairment, or cosmetic changes, especially in complex head and neck sites.

Brachytherapy is an attractive option for patients with tumors in sensitive or difficult-to-reach areas, or for those who prefer a treatment that avoids significant surgical intervention. Studies have shown that brachytherapy can achieve comparable local control rates to surgery in select cases, especially for tumors that are not easily resected. However, surgery might provide a more immediate and definitive treatment in terms of tumor removal.

A study by Zhao et al., published in the Journal of Contemporary Brachytherapy in 2022, assessed Stereotactic Ablative Brachytherapy (SABT) for unresectable/inoperable head and neck cancers in 37 patients. Results showed good local control and mild adverse reactions. Key data: Local Control Rate (LCR) at 6, 12, and 24 months was 89.2%, 78.2%, and 69.4%, respectively.

The Overall Survival (OS) rate at 6, 12, and 24 months was 97.3%, 70.3%, and 34.5%, respectively. The median survival time was 16 months (95% CI: 10.5-21.5 months). Adverse reactions (Grade 1-2 skin/oral mucosal) occurred in 18.9% and 10.8% of cases, respectively, with no Grade 3 or higher reactions reported. The study concluded SABT is safe, feasible, minimally invasive, and effective for local control with fewer adverse effects compared to other treatments.

Brachytherapy vs. External Beam Radiation Therapy (EBRT)

EBRT for head and neck cancers typically involves external radiation delivered over a series of sessions. While EBRT is effective, it tends to affect surrounding healthy tissues, which may lead to long-term side effects such as xerostomia (dry mouth), dysphagia (difficulty swallowing), and skin changes. Brachytherapy, in contrast, is a more localized treatment that delivers higher doses of radiation directly to the tumor site, sparing surrounding healthy tissue.

This makes it a beneficial option for small, localized tumors, where higher doses can be administered with minimal damage to nearby organs. Studies comparing the two modalities have suggested that brachytherapy might offer superior outcomes in specific situations, such as for recurrent or recurrent head and neck cancers where previous EBRT has already been utilized. Additionally, brachytherapy can offer quicker treatment times and fewer sessions, which may improve patient convenience and quality of life.

Brachytherapy vs. Chemotherapy

Chemotherapy is often used in advanced or metastatic head and neck cancers, either alone or in combination with radiation, to target rapidly dividing cancer cells. While chemotherapy can be effective in treating systemic disease, it does not offer localized control and can come with significant systemic side effects, such as nausea, hair loss, and immunosuppression.

Brachytherapy, as a localized form of radiation, provides targeted treatment directly to the tumor, offering a curative intent in early-stage or localized head and neck cancers. Unlike chemotherapy, it typically comes with fewer systemic side effects. In cases where chemotherapy is combined with brachytherapy, it may improve outcomes by reducing tumor size before radiation is applied, but this combination requires careful consideration of potential side effects.

Brachytherapy vs. Active Surveillance

Active surveillance in head and neck cancer refers to monitoring low-risk tumors without immediate treatment, and it is often used in early-stage or indolent cancers that may not require immediate intervention. Brachytherapy, in contrast, is considered when there’s a progression of the disease or if patients opt for active treatment over continued observation. For patients with early-stage cancers that are unlikely to progress quickly, active surveillance can be a viable option, especially in cancers of the oral cavity or larynx. However, for tumors that are at risk of progression or for patients who prefer immediate intervention, brachytherapy provides an effective, less invasive treatment alternative to surgery or external radiation.

Brachytherapy vs. Targeted Therapy

Targeted therapy in head and neck cancers focuses on specific molecular targets that contribute to cancer cell growth and survival. It is often used in advanced or recurrent cancers, especially those with specific genetic mutations. While targeted therapy can provide effective systemic control, it does not offer the localized tumor control that brachytherapy provides.

Brachytherapy, with its ability to deliver high radiation doses directly to the tumor while minimizing exposure to surrounding tissues, may be a more suitable treatment option for localized head and neck cancers. It can be combined with targeted therapies for more advanced cases, but typically, brachytherapy is considered for localized, smaller tumors or in settings where surgery or external radiation would be less effective or feasible.

Can All Head and Neck Cancer Patients Receive Brachytherapy?

Brachytherapy is a specialized radiation treatment where radioactive sources are placed close to or directly within the tumor. It is particularly effective for certain head and neck cancers, including early-stage oral cavity tumors (like lip, tongue, or floor of mouth), oropharyngeal cancers, and some recurrent cases where re-irradiation is considered. However, it is not suitable for all patients. The feasibility depends on tumor size, location, prior treatments, and patient anatomy.

According to ESTRO and the Groupe Européen de Curiethérapie (GEC-ESTRO) guidelines, brachytherapy is best suited for patients with localized tumors and no evidence of extensive nodal involvement. It can be used alone or as a boost in combination with external beam radiation therapy (EBRT), particularly in tongue or lip cancers. In recurrent cases, especially after prior radiation, interstitial brachytherapy can offer a curative option when surgery is not possible.

Patients with deeply infiltrative disease, significant bone invasion, or tumors adjacent to critical structures like the carotid artery may not be ideal candidates. The decision requires a multidisciplinary evaluation involving radiation oncologists, head and neck surgeons, and radiologists.

How Does Brachytherapy Affect Sexual Health and Fertility?

While head and neck brachytherapy does not directly involve reproductive organs, its physical and psychological effects can still influence sexual health and intimacy. Treatment-related factors such as fatigue, pain, mucosal changes, xerostomia, and body image issues—particularly in visible areas like the face and neck—can contribute to reduced libido, altered self-esteem, and discomfort during intimacy. It’s essential that healthcare providers proactively address these concerns and encourage open communication to ensure holistic cancer care.

Sexual Health

Sexual dysfunction in patients undergoing head and neck brachytherapy is often multifactorial. Changes in appearance, speech, and swallowing function may affect self-image and partner relationships, contributing to decreased sexual desire or activity. A prospective study by Dhanuthai et al. (2013) in Supportive Care in Cancer highlighted that quality-of-life scores in head and neck cancer survivors were significantly associated with sexual functioning, particularly in those treated with radiotherapy. Anxiety, depression, and fear of recurrence further compound these challenges.

Supportive interventions such as counseling, peer support groups, and psychosexual therapy can help patients and partners navigate these changes. Addressing pain and dry mouth, along with speech and swallowing rehabilitation, may indirectly improve comfort and confidence in intimate settings.

Fertility

Head and neck brachytherapy does not typically impair fertility directly due to its localized application and distance from reproductive organs. However, systemic treatments used in combination—such as chemotherapy or, rarely, hormonal therapies—may have broader effects. Additionally, younger patients with HPV-positive oropharyngeal cancers may raise fertility concerns due to potential adjunctive treatments.

Although fertility preservation is not routinely indicated for patients undergoing head and neck brachytherapy alone, it may be appropriate to counsel select younger individuals receiving multimodal therapy. Emotional and reproductive counseling should be integrated into survivorship care, particularly for adolescent and young adult (AYA) patients.

Read OncoDaily’s Special Article About Brachytherapy 

Recovery After Brachytherapy for Head and Neck Cancer

Recovery after head and neck brachytherapy involves a gradual return to normal activities while managing side effects and promoting healing in the treated area. In the initial days following treatment, patients are typically advised to rest and avoid strenuous activity, especially anything that might irritate the implant site or interfere with healing. Discomfort or localized symptoms such as swelling, pain, or mucosal irritation are common, particularly in areas like the oral cavity, pharynx, or larynx. These effects are usually temporary but may require supportive care.

Patients often experience difficulty swallowing, dry mouth, changes in taste, and mild hoarseness depending on the treatment site. Maintaining good hydration and oral hygiene, consuming soft and nutritious foods, and following recommendations for pain and symptom relief can support recovery. Speech and swallowing difficulties may persist in some cases and benefit from early referral to speech-language therapy.

Fatigue is a common side effect in the early recovery phase, especially if brachytherapy is combined with external beam radiation or chemotherapy. Managing energy levels through adequate sleep, hydration, and proper nutrition is important. Emotional and psychological challenges are also not uncommon due to functional or cosmetic changes following treatment, and access to psychosocial support can significantly improve quality of life.

Although most side effects are mild to moderate and resolve over time, patients should be alert for signs of complications such as severe pain, ulceration, infection, or difficulty breathing or swallowing. Any new or worsening symptoms should prompt immediate contact with the healthcare team.

Ongoing follow-up is crucial to assess healing, monitor for recurrence, and manage late effects of treatment. Imaging and clinical evaluations will be part of routine post-treatment care, helping to ensure long-term treatment success and overall well-being.

How Can Patients Support Their Health During Brachytherapy for Head and Neck Cancer?

During recovery from brachytherapy for head and neck cancer, patients can take several steps to support healing and overall well-being. It’s important to attend all scheduled follow-up appointments and carefully follow the care team’s pre- and post-treatment instructions. This helps ensure optimal treatment outcomes and allows for early detection and management of any complications. Patients should promptly report symptoms such as worsening pain, difficulty swallowing, fever, or signs of infection to their healthcare provider.

Staying well-nourished supports the body’s healing process. Patients should aim to eat a balanced diet rich in fruits, vegetables, and proteins while avoiding irritants like spicy foods, alcohol, and tobacco. In some cases, dietary consultations may be needed to address difficulty eating or weight loss. Maintaining hydration is equally important, particularly in the presence of dry mouth or mucositis.

Rest and gentle movement play an important role in recovery. Fatigue is common after treatment, so allowing the body adequate time to rest is vital. With approval from the healthcare team, light physical activity such as walking can help with circulation, mood, and energy levels. It may also reduce the risk of deconditioning and improve overall wellness during the recovery phase.

Emotional recovery is another essential aspect of healing. Patients may experience feelings of anxiety, changes in self-image, or concerns about speech, swallowing, or social interactions. Connecting with a counselor, support group, or trusted individuals can provide valuable emotional support. Open discussions with the care team about any concerns—whether physical or emotional—can help patients feel more confident and informed throughout their recovery journey.

By staying engaged with their healthcare team, maintaining a healthy lifestyle, and seeking support when needed, patients can actively contribute to a smoother recovery and improved quality of life following head and neck brachytherapy.