Brachytherapy in Tunisia

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About the Brachytherapy

Brachytherapy is an advanced form of radiation therapy. It is also known as internal radiation therapy. Radiation therapy is a type of cancer treatment in which ionizing radiation is used to destroy cancer cells and shrink the size of the tumors. The conventional form of radiation therapy is external beam radiation that projects radiation from a machine outside of the body. In case of internal radiation or brachytherapy, radioactive particles or sources that are internally placed in or next to the tumour site, are used to destroy cancer cells. Brachytherapy helps deliver a high radiation dose to the tumor, with minimal exposure to the surrounding healthy tissues.It thus allows delivering high doses of radiation to more-specific areas of the body.

Brachytherapy can be used for effective treatment of cervical, prostate, breast, skin, lung, head and neck, and gum cancer, in addition to tumors located in other parts of the body. Brachytherapy for prostate cancer is a commonly performed procedure. It is also used for the treatment of gum cancer as well. Brachytherapy is an alternative treatment for gum cancer and is conducted who are unfit to undergo a surgery or do not need one.

Brachytherapy can be completed in less time than other conventional radiotherapy techniques. Brachytherapy for prostate cancer and other cancers is often performed on an outpatient basis and patients typically have to take fewer brachytherapy sessions, as compared to external radiotherapy treatment for cancer. This makes brachytherapy more accessible and convenient to many patients. Most of the patients are able to tolerate brachytherapy very well with fewer side effects.

Types of Brachytherapy

There are two types of brachytherapy treatment:

  • Temporary brachytherapy:

    In this method, highly radioactive particles are placed in a catheter or slender tube for a specific amount of time and then withdrawn. Temporary brachytherapy can be administered at either low-dose rate (LDR) or high-dose-rate (HDR).

  • Permanent brachytherapy:

    In this method, a radioactive seed or pellet is implanted in or near the tumor and left there permanently. After a period of several months, the radioactivity level of the implanted seed eventually diminishes to nothing.

How is Brachytherapy performed?

Brachytherapy treatment plan is created and governed by a radiation oncologist, who is a highly trained physician specializing in treating cancer with radiotherapy. The radiation oncologist will require a team, including a medical physicist, dosimetrist, radiation therapist, radiation therapy nurse and in some cases, a surgeon to conduct the procedure. However, the radiation oncologist is the one who evaluates the patient and determines the appropriate therapy, including how much radiation to deliver.

In permanent brachytherapy, needles that are pre-filled with the radioactive brachytherapy seeds are inserted into the tumor. Then the needle or device is removed, leaving the radioactive seeds behind. Sometimes these seeds may be implanted in sessions using a device that inserts them individually at regular intervals. An appropriate imaging means such as an ultrasound, X-ray, MRI or CT scan may be used to assist the physician in positioning brachytherapy seeds at the right place. After implantation, some additional imaging can be done to verify seed placement.

Temporary brachytherapy starts with placing a delivery device, such as a catheter, needle, or applicator, into the tumor. Methods of imaging such as an ultrasound, MRI, or CT scan will help position the radiation sources correctly. The delivery device can either be inserted into a body cavity such as vagina (intracavitary brachytherapy) or applicators such as needles or catheters can be inserted into body tissues (interstitial brachytherapy). Device implantation will depend on the location of cancer.

Radiation using brachytherapy procedure can be delivered at three different levels:

  • High-dose-rate (HDR):

    HDR brachytherapy is given for over 10 to 20 minutes per session, but it can take several hours worth of preparation, which includes device placement. HDR brachytherapy is mostly conducted as an outpatient procedure, although sometimes patients are admitted for one to two days to have several HDR brachytherapy sessions using the same applicator.

    HDR brachytherapy delivers a specified dose of radiation to the tumor in a short burst using a remote-afterloading machine. This will help protect the patient from unnecessary exposure to radiation. This procedure can be repeated a couple of times on the same day.
  • Low-dose rate (LDR):

    LDR is delivered at a continuous rate of radiation for over 20 to 50 minutes. The patient needs overnight hospitalization so the delivery device can remain in place throughout the treatment. The radiation oncologist may insert the radioactive particle manually through the delivery device and remove the material and delivery device after the treatment.

  • Pulsed dose-rate (PDR):

    PDR brachytherapy is delivered in a similar way of LDR, but the treatment takes place in periodic pulses instead of continuous radiation. 

Recovery from Brachytherapy

For patients who have received brachytherapy for prostate cancer or any other types of cancer, limiting physical activity for at least three to five days is important. You can experience some level of grogginess after the procedure, however, it will last for only a few hours. You will be prescribed a few emergency medicines that you can take in case you experience pain or any other type of discomfort.

There are some side effects associated with all kinds of radiation therapy. However, the acute, sub-acute, or long-term side effects of brachytherapy depend on the location of the tumor being treated and the type of brachytherapy being used.

Some acute side effects of brachytherapy are

  • Localized bruising,
  • Bleeding, swelling,
  • Fatigue and discomfort within the implanted region.

But these are temporary side effects and usually resolve within a few days following completion of treatment.

Usually, brachytherapy does not cause any long-term side effects, but in a few cases, it may cause urinary and digestive problems. But in that case as well, long-term side effects are usually mild or moderate in nature and there are many palliative medicines that are available to cope with the symptoms.

Patient Stories

Frequently Asked Questions

What is the health care infrastructure of Tunisia / Why should opt for Tunisia as a destination for your medical treatment?
Hospitals in Tunisia are developing and trying to meet the international standards of healthcare. Although there is a basic set up in most of the hospitals for treatment in Tunisia, one can still expect scope for improvement. The Ministry of Health, along with the Government of Tunisia is making effective changes for the healthcare sector. The private hospitals in Tunisia are also undergoing a robust change to provide effective healthcare and treatment in Tunisia.

Like most other countries, hospitals in Tunisia have a private and public healthcare system. Hospitals in Tunisia include three levels of care: primary, with a network of 81 clinics and 2091 basic health centers; secondary, with 109 district hospitals; and tertiary, with 33 regional hospitals and 24 modern CHUs, according to MoS figures.
What are the conditions of the hospitals in Tunisia? Are they JCI certified? What is the quality of the support staff in the hospitals?
The Joint Commission International (JCI) is a global leader in health care accreditation. JCI accreditation is considered a gold standard in worldwide health care. It provides the most skilled and experienced healthcare professionals in the medical industry, as evaluators of the rigorous international standards in healthcare quality and patient safety.
In Tunisia, there are no JCI accredited hospitals but 4 private hospitals are certified ISO and OHSAS (Occupational Health and Safety Assessment Series).
Are the doctors/surgeons in Tunisia of the best quality?
The hospitals in Tunisia have seen a constant change in terms of development and technology. Most doctors that are trained in the country understand the needs and requirements of people and are able to diagnose and treat them well. There are various surgeons that fly in from other countries as well to treat patients. This was brought about due to the economic reforms and various expats residing there. The varying levels of health organizations provide reasonable means of treatment for any patient. There are also trained paramedical and emergency service staff in this country.
What is the process for obtaining a medical visa in Tunisia?
Patients who wish to visit Tunisia for medical purposes must contact the Embassy of Tunisia in their home country. One is required to have a valid passport. Those applicants must submit their visa application forms in person together with the following documents:
  1. A duly completed application form with one picture (within a white background).
  2. Original biometric passport and one copy. Passports should have a validity of at least one year from the date of your visa application submission.
  3. Medical certificate stating the type of illness and the treatment to be carried out. This document has to be in English or Spanish language.
  4. Letter from the hospital in Tunisia stating the appointment date and whether the treatment expenses have been already paid in full.
  5. Proof of financial means which enable the applicant to meet life needs while in Tunisia (salary certificate if working, bank statement for the last six months, property deeds, commercial license, other sorts of income).
  6. Travel insurance.
  7. Proof of accommodation (hotel reservation, etc)
  8. Applicants are advised that ALL PASSPORTS HAVE TO REMAIN at the Embassy premises while the visa application is under process (between 10 and 15 days), and therefore cannot be retrieved unless very special and urgent circumstances might arise.
  9. The Embassy has the right to require from the applicant any document that it may deem relevant in order to resolve the visa file.
What support services does MediGence provide in Tunisia?
MediGence enables you to plan and manage your medical decisions better. These are some of our services offered:
  • Expert Opinion
    We help you seek an Expert Opinion on your diagnosis and treatment from an experienced team of doctors at MediGence and specialists from a reputable hospital.
  • Hospital Recommendation
    We recommend a hospital or a healthcare institution that is best suited for you, based on your ailment and its criticality.
  • 360-degree Hospital Review
    We give you a transparent and holistic view of the hospital and its infrastructure, accreditation, facilities, and expertise to give you confidence.
  • Doctor Validation and Communication
    We share a comprehensive profile of the treating doctor and also arrange a call to clear queries regarding treatment if needed.
  • Options to Choose From
    Based on your choice of destination and other preferences, we provide you multiple options with respect to hospitals and doctors to choose from.
  • 24X7 Patient Care Support
    A dedicated patient case manager stays in constant touch with you to help you at every step of the decision-making process and resolve queries that you may have.
  • Transparent Treatment Cost and Other Expenses
    We give a clear and accurate indication of the total cost of treatment including treatment, stay, meals, and other expenses.
  • Visa Assistance
    We provide and help prepare documentation for visa approval and coordinate with the embassy to expedite the visa process.
  • Accommodation Arrangements
    We propose to you a choice of accommodation based on your preference such as long stay, short stay, or luxury properties.
Which are the best cities in Tunisia for medical treatment?
Tunis is the largest country and capital of Tunisia. This country is located in the northern region of Africa and is the best city for treatment in Tunisia.

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