High dose rate (HDR) brachytherapy (also called internal radiation treatment) is used at Plymouth Oncology Centre to treat Gynaecological cancers. This is for cancer of the cervix and endometrium. You may have been referred for brachytherapy here if you live in the Plymouth area or in Cornwall.
Brachytherapy can be used alone, after surgery, or in combination with external beam radiation. By placing applicator tubes inside the body (inside the vagina and/or cervix depending on which type of cancer you have), a higher dose treatment can be delivered.
Once the applicators are in place, the Brachytherapy radiographers will connect them to hollow tubes which are also attached to the treatment machine. During the treatment, the computerised machine will deliver a small radioactive pellet down the tubes and it will lodge inside the applicator and give off radiation treatment inside the body, cervix or vagina.
The radioactive source will automatically travel back into the machine when the correct dose has been given. You will not be radioactive and there are no restrictions afterwards.
During this time, you will not feel anything but you will need to lie still on the treatment couch. The staff will leave the room as they cannot be in the room during treatment delivery. The staff will watch you carefully the whole time on a CCTV camera and are able to come in if needed. The treatment takes 5-10 minutes to deliver.
If you are having Brachytherapy for Cancer of the Endometrium, the applicator will be removed afterwards and treatment will be on an outpatient basis.
If the Brachytherapy is for Cancer of the cervix, you will be admitted to Brent ward the night before and for the duration of the treatment.
Brachytherapy for Ca Endometrium (womb)
The treatment length will be discussed with you but in general we give four treatments (intravaginally) if surgery alone has been done to remove the womb.
Some patients require external beam radiotherapy before the brachytherapy treatment and this will be two sessions, usually the week following completion of the external beam.
As an outpatient you will attend the Bluebell suite in Radiotherapy, level 2. Before the first treatment can be given, the Oncologist will need to examine you internally, similar to a smear test. This is to check inside is fine and to get the correct size applicator for you.
This will be placed gently into the vagina. You may experience discomfort and we can prescribe pain relief if you need it. There is no need for an anaesthetic but you may be given a tablet to help relax you.
Once the applicator is in place, you will need to lie on the couch fairly flat until treatment is complete. The treatment will take place later in the day as several hours is needed to plan the treatment from a CT scan that you will have checking the applicator is in place. You will be cared for by the staff in the Bluebell suite during this time and can have a relative/carer with you.
When the treatment plan is ready you will be wheeled on the couch into the treatment room.
Everything inside you will be removed after treatment is given and you can go home to return for subsequent treatments. We do not recommend that you drive to this appointment or get public transport.
The staff will discuss your appointments with you but treatments are usually done on Tuesdays and Fridays.
Subsequent visits will be much shorter because the scan and planning part is already done from the first day. Please allow approximately an hour for subsequent appointments.
Brachytherapy for Cervical Cancer (intrauterine)
This treatment is given as an internal boost to the cervix and top of the vagina following completion of external beam radiotherapy.
The course of brachytherapy treatment can be four treatments over three days or two treatments with a further two given the following week. This will be discussed with you by the oncologist prior to the treatment.
You will need to be admitted onto Brent Ward, Level 8 the day prior to the first treatment, and will be cared for by the staff for the duration of the brachytherapy. The brachytherapy will be delivered by radiographers on Level 2.
In order to place the applicators inside you in the correct place to deliver treatment you will need a general anaesthetic or a spinal and you will go to theatre for this procedure.
When you wake up in recovery you will be lying flat on a bed with the applicators inside you, unable to sit up or move very much. There will be gauze packing inside the vagina to help keep everything in place and a catheter in your bladder as it is not possible to get out of bed to go to the toilet. If you experience discomfort or pain you will be given pain relief.
After placing the applicators, you will need to have an MRI and CT scan. This allows the staff to plan your treatment to ensure the correct dose is delivered where it is needed.
You will be on Brent ward until the first treatment on Tuesday late afternoon. Further treatments will take place and CT scans to plan each treatment for you over the next few days.
The nursing staff will look after you and you will not be radioactive so visitors are allowed during this time.
At the end of the brachytherapy, the applicators and packing are removed along with the catheter in your bladder. This will be done in the bluebell suite in Radiotherapy. You will be offered Entonox (gas and air) as extra pain relief. As soon as everything is removed you will be able to sit up and when feeling alright can go home from the ward. This may be the following day.
You may experience some side-effects, these are normal and usually last a few days only. You will be given an aftercare booklet with relevant contact numbers for advice if you need this or you can visit your GP.
Short Term Side Effects
Spotting- or slight bleeding from the vagina or vaginal discharge. If this does not settle or becomes smelly you may have an infection so see your gp.
Urinary tract infection- this can be due to having a catheter in your bladder, and pain/discomfort on passing urine(cystitis) may indicate this. If concerned please contact your gp as you may need antibiotics. Please drink plenty of fluids.
Bowel Irritation- you may experience or more frequent bowel movements/sensation of needing to empty your bowels.
Vaginal soreness-This is due to examination and treatment.
Long Term Side Effects
Brachytherapy can cause scar tissue to form slowly in the tissues around the treatment area in the vagina. The vagina can become less elastic and narrow or shorten as a result of this. This can cause possible discomfort or pain during intercourse or medical examination internally.
The vagina can become dry and the use of a vaginal moisturiser or if sexually active, using a water-based lubricating gel can be helpful.
This is a way of helping to breakdown scar tissue formation inside the vagina and helps reduce problems with examination or sex. You will be offered a dilating pack by the nurse specialist on your first follow-up appointment. Dilating involves gentle insertion of plastic, cylinder-shaped tubes into the vagina on a regular basis, a few times a week for a few minutes each time. This is recommended even if you are sexually active following treatment.
The first clinic appointment will be given to you or sent in the post for 6-8 weeks following completion of the brachytherapy.
For patients referred from Cornwall for brachytherapy, follow up will take place in Truro with your original oncologist. Please ensure you get an appointment for this.
In addition to the professionals you will see during your brachytherapy treatment, at Derriford there is a support centre called “The Mustard Tree”. It is a Macmillan support centre and help can be accessed before, during and after treatment. It is located on Level 3, above the Oncology centre.
Many patients find this is a stressful and anxious time so it is important that you let us know how you are feeling as there is help available. Support can help your emotions feel more manageable so please remember we are here if you have any worries or concerns.
Brachytherapy Radiographer- Tel: 01752 37032