Brachytherapy
In brachytherapy, the radiation originates inside the body. It uses gamma
ray-generating radioactive isotopes like cesium-137 or iodine-125, placed in small tubes
and implanted close to the tumor. The patient stays in the hospital for a few days; after
that time, the radioactive isotope either has decayed to a low level, or the implant is
removed. This form of therapy is especially useful for tumors where surgery or radiation
would be critically detrimental to tissues surrounding the tumor. Brachytherapy has been
effective against prostate cancer and cervical cancer.
More detailed information about Brachytherapy
This type of internal radiotherapy treatment is used for treating cancer of the cervix,
uterus or vagina. The radioactive source most commonly used is called caesium-137. The
advantage of caesium insertion treatment is that it gives a high dose of radiotherapy
directly to the tumour, but a low dose to normal tissues.
The caesium source has to be put inside an applicator (perhaps more than one) to keep
it in place. The applicator is inserted into the vagina while you are under a general
anaesthetic or sedation in the operating room. At the same time, a flexible tube called a
urinary catheter may be put into your bladder to drain off urine. This means you will not
have to get on and off bedpans, which could dislodge the applicators.
Once the applicators are in place, an x-ray will be taken to check they are in the
correct position. Sometimes the radioactive source is put into the applicator while you
are in the operating room, but more commonly it will be put in place once you are back on
the ward. You may hear this referred to as `afterloading'.
The applicators are kept in place by a pack (cotton/gauze padding) inside your vagina.
This can be uncomfortable and you may need to ask your nurse for regular painkillers.
Once the source is put into the applicators you have to stay in bed, which helps keep
them in the correct position. If you need anything, you can call a member of staff by
using the bell by your bed. If the source does get dislodged, you should call the staff on
the ward immediately.
Side effects of Brachytherapy
It is not unusual to have slight bleeding or discharge once the radiotherapy treatment
has ended. If it continues or becomes heavy it is important to let your doctor or nurse
know.
Radiotherapy to the pelvic area can cause side effects such as tiredness, diarrhoea and
a burning sensation when passing urine. These side effects can be mild or more troublesome
depending on the strength of the radiotherapy dose and the length of your treatment. Your
oncologist will be able to advise you what to expect.
Most of these side effects can be treated with medicines, which your oncologist will
provide. Any side effects should gradually disappear once your treatment is over.
It is important that you drink plenty of fluids and maintain a healthy diet during your
treatment. If your diarrhoea is not controlled with medicines you can ask to see a
dietitian, who can advise you on what to eat to reduce diarrhoea. You may feel sick but
this is not common. If you don't feel like eating, you can replace meals with nutritious
high-calorie drinks, which are available from most chemists and can be prescribed by your
GP.
Radiotherapy for cancer of the cervix affects the ovaries, unfortunately, and this
brings on the menopause, usually about three months after the treatment starts. This means
that your periods will stop and you will have menopausal side effects such as hot flushes,
a dry skin and possibly loss of concentration. Some women become less interested in sex
and notice that their vagina is dry. Sometimes radiotherapy causes a narrowing of the
vagina, which can make sexual intercourse uncomfortable. See page 42 for advice on how to
deal with the effects on your sex life and fertility.
You can be protected from menopausal side effects by taking HRT (hormone replacement
therapy) as tablets or skin patches. These can be started by your gynaecologist during the
radiotherapy treatment or shortly after it has ended. They will help choose the correct
replacement hormones and dosage.
It is important to get as much rest as you can, especially if you have to travel a long
way for treatment each day.
Possible long term side effects of Brachytherapy
Radiotherapy to the pelvic area has sometimes led to long-term side effects. However,
improvements in the treatment-planning have made these much less likely.
In a small number of people, the bowel or bladder may be permanently affected by the
radiotherapy. If this happens the increased bowel motions and diarrhoea may continue, or
the patient may need to pass urine more often than before. The blood vessels in the bowel
and bladder can become more fragile after radiotherapy treatment and this can cause blood
to appear in the urine or bowel movements. This can take many months or even years to
occur.
If you notice any bleeding it is important to let your doctor know so that tests can be
done and appropriate treatment given.
CancerBACUP has a leaflet Pelvic radiotherapy: what you need to know, that has tips on
coping with these side effects.
Some people also find that the radiotherapy affects the lymph glands in the pelvic area
and can cause swelling of the legs. Known as lymphoedema, this is more likely if you have
had surgery as well as radiotherapy.
After caesium insertion there is a slight risk of infection, but this is very rare. If
you do develop a high temperature or heavy bleeding after your treatment you should
contact your specialist as soon as possible. You will be prescribed antibiotics to treat
the infection. |