Brachytherapy for Uterine Cancer
Brachytherapy is when doctors put radiation right in the tumour while sparing healthy body parts. Women with uterine cancer often have brachytherapy after surgery to remove the uterus.
When radiation oncologists use brachytherapy like this, the goal is to reduce the chance of the cancer coming back to the top part of the vagina known as the ‘vaginal vault’. Brachytherapy is very effective for this and has few side effects.
Some people also need external beam radiation therapy, which may be used with or without chemotherapy and surgery.
Where doctors can’t operate, radiation therapy is used as the main treatment. Radiation oncologists use both external beam radiation therapy and brachytherapy when it is the main treatment.
Most centres in Australia do high dose rate brachytherapy, which is when people get a high dose of radiation in a very short time (usually minutes) while they are under an anaesthetic.
During low dose rate brachytherapy, people get treatment over a longer time (usually several days), which means they must stay in hospital.
Both high dose and low dose rate brachytherapy are effective for treating cervix cancer.
The number of treatments varies, and radiation oncologists make a treatment plan to best suit the needs of each person.
What is the procedure for treatment?
Vaginal vault brachytherapy
Radiation oncologists do vaginal vault brachytherapy 4-6 weeks after surgery to give you time to heal. The treatment is simple, and you won’t need an anaesthetic. During treatment the radiation oncologist inserts an applicator in your vagina while you lie on a treatment couch. The doctor will fix the applicator in place, so it doesn’t move. The treating team will be there to make sure you are okay.
There are many different applicators, and your radiation oncologist will choose the one that will work best for you. The picture below is one type.
The radiation oncologist uses cables to attach the applicator to a shielded container where the radiation source is kept when not in use. During treatment, the radioactive source moves from a shielded container through the cables into the applicator. After treatment, the radioactive source goes back into the shielded container. You need to lie still but you can’t feel the treatment. The staff leave the room during treatment.
There is a camera and microphone in the treatment room, and if you need anything you can call out and wave your hands. The team will stop the treatment and come and check on you.
Vaginal vault brachytherapy takes around 20 minutes and once you’ve had the applicator removed you can go home.
Side effects
The side effects of radiation treatment can be split into 2 groups:
- Early side effects which occur during and shortly after radiation treatment.
- Late effects which can occur months to years after radiation treatment
Potential Early Side Effects – Vaginal vault brachytherapy
During and shortly after treatment
Most women cope well with vaginal vault brachytherapy, but some side effects may include:
- Mild discomfort when the applicator is inserted
- Some spotting of blood or discharge after treatment, which normally settles quickly
- Urinary irritation women may need to pee more often or feel burning for a few weeks
- Tiredness although this is less common
- Muscle pain from lying on the treatment couch
- Irritation of the vaginal surface, this is usually mild
Potential long-term side effects
- Severe long-term side effects are rare
- Mild fibrosis of the upper vagina can occur. This can cause a dry, narrow or shortened vagina, which may lead to pain during intercourse or bleeding. If needed doctors can give women a vaginal dilator to help.
- Chronic ulcer of the vagina, this is very uncommon
- Long term issues with bowel and bladder are very rare.
Primary radiation therapy for uterine cancer
In some cases, radiation oncologists use both brachytherapy and external beam radiation therapy.
External beam radiation therapy is delivered from outside the body. Radiation oncologists use it to treat the uterine cancer and areas where it has spread, such as the lymph nodes.
They then do brachytherapy, which gives a high dose of radiation to the tumour, while sparing healthy body parts. This increases the chances of a good outcome without hurting surrounding areas.
A special team which includes a radiation oncologist, surgeon, radiation therapist , medical physicist, radiologist and anaesthetist does brachytherapy.
To prepare for brachytherapy you have an examination and blood tests. Some people also have an MRI. Doctors sometimes recommend a special diet before the procedure and an enema.
People usually have brachytherapy under a general anaesthetic, which means fasting for 6 hours before the operation. Sometimes, doctors do an anaesthetic in the back, this is called a spinal or epidural, to block pain in the lower part of the body.
People get brachytherapy in a special treatment room, and it takes 20-30 minutes.
During the process doctors insert a urinary catheter into the bladder, open the cervix and place hollow tubes, or needles, next to the uterus and tumour. These are called applicators. The doctors use an ultrasound to make sure the applicators are in the right spot and sometimes an x-ray to double check.
The radiation oncologist uses Vaseline gauze or stitches to keep the applicator in the right place.
Doctors do a scan to check the applicators are in the right spot before starting treatment. In some centres, you will be woken for the scan after the applicators are inserted. The radiation oncologist uses these images to carefully plan the treatment. After doctors have confirmed and checked they bring you in for treatment. Some centres do the planning and treatment while you’re under the general anaesthetic.
During treatment, the radioactive source moves from a shielded container through cables into the applicators. After treatment, the radioactive source goes back into the shielded container. You can’t feel the treatment.
Results of brachytherapy
Vaginal vault brachytherapy is very effective for reducing the chances of the cancer coming back to the vaginal vault.
When radiation is used as the main treatment for uterine cancer and doctors use brachytherapy with external beam radiation therapy, it increases the chances of a good outcome with few side effects.
