Intra-Uterine Brachytherapy

  • Reference Number: HEY-036/2016
  • Departments: Oncology (Cancer Services), Radiotherapy

Introduction

This leaflet has been produced to give you general information about your treatment.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is Brachytherapy?

Brachytherapy is a form of radiotherapy where a radioactive source, iridium, is stored and delivered via a treatment machine called Flexitron. The radioactive source is placed close to the tumour or post operatively placed near the scar in the vagina. The purpose of this technique is to deliver a direct dose to the area concerned, minimising the dose to the normal surrounding tissue. The radioactive source is only active when Flexitron is switched on, therefore you will not be radioactive to any other person after treatment.

What do I need for my Intra-Uterine Brachytherapy?

The brachytherapy procedure requires you to undergo a general anaesthetic to insert the applicators. You will be admitted to Ward 30 at the Queen’s Centre on the day before the procedure. Whilst undergoing your external beam treatment, we will arrange for you to see the ward staff to organise your admission and pre-assessment.

We would advise you to bring an overnight bag and any medication that you are taking. Prior to your treatment, we would also advise a low fibre diet.   You should have nothing to eat or drink after midnight on the night before the procedure.

What will happen?

Intra-Uterine Brachytherapy treatment is usually given in three treatments.  These treatments take place across two weeks and require two general anaesthetics.  The first week of treatment requires a two night stay and the second week an overnight stay.

Due to demands on the service your appointments may vary from this schedule.

Week 1 You will be admitted onto the ward on the day prior to your first treatment (MONDAY) Week 1 and third treatment (WEDNESDAY) Week 2.

brachytherapyTable1

Tuesday, first treatment

On the morning of your first treatment you will be taken to theatre at about 07.30am to prepare you for your anaesthetic. Once anaesthetised the doctor will examine you and insert the applicators.  As these applicators have to stay in place until you are discharged, a catheter is put into your bladder to enable you to pass urine. The applicators will be kept in place with gauze packing until removed.  A step-by-step process is noted below:

  • Theatre (anaesthetic given, applicators and catheter inserted)
  • Recovery
  • CT scan
  • MRI scan
  • Return to Ward 30 whilst your treatment is being planned (approx 2 hours)
  • Taken to Brachytherapy Suite for treatment (approx 30 minutes)
  • Return to ward with applicators in place, ready for Wednesday’s treatment

Wednesday – second treatment

The step-by-step process is as follows:

  • Taken from the ward to CT scan
  • Taken to Brachytherapy Suite for treatment (approx 30 minutes)
  • Removal of applicators in the Brachytherapy Suite
  • Return to ward for catheter removal and discharge until next Wednesday’s admission

Week 2

Thursday – third treatment

The step-by-step process is as follows:

  • Theatre (anaesthetic given, applicators and catheter inserted)
  • Recovery
  • CT scan
  • Return to Ward 30 whilst your treatment is being planned (approx 2 hours)
  • Taken to Brachytherapy Suite for treatment (approx 30 minutes)
  • Removal of applicators in Brachytherapy Suite
  • Return to the ward for catheter removal and final discharge

After catheter removal and before you can go home, the ward staff have to ensure you can pass urine.

On the final third treatment your anaesthetic may still be in your system and therefore you must not drive yourself home as you may feel sleepy for up to 24 hours.  If you have any transport queries, check with the ward staff.

If you have received external beam radiotherapy then your brachytherapy will not commence immediately.  You will be booked into the next available theatre session. Appointments will be pre-booked by our booking coordinators and you will be informed by post. The Brachytherapy team will provide information prior to the procedure during your course of external beam radiotherapy.

Treatment Delivery

The applicators will be connected via a small hollow flexible tube to the Flexitron. The radioactive source travels down the hollow tube on a thin wire and stops at programmed points to deliver the planned dose. The Flexitron will be switched on once the radiographers have left the room and closed the door. The radiographers can communicate with you over the intercom and will monitor you on close circuit television (CCTV). When the treatment is complete, the radiographers will re-enter the room. If it is your first treatment, you will return to the ward with applicators in place. If it is your second or third treatment, they will be removed in the Brachytherapy Suite.

Student Radiographers

As we are a teaching hospital it is possible there may be some male and female student radiographers working with us during the time of your treatment. If you would prefer them not to be present during your treatment, please make the radiographers aware before your treatment commences.

What happens afterwards?

After your treatment, the radiographers will explain the possible side-effects again and will be able to answer any questions. You will see your doctor approximately six weeks after your treatment is complete.

Acute side-effects

It is quite normal to experience slight bleeding and vaginal discharge after the treatment; the discharge may appear yellow/brown in colour and this is due to the gauze packing used in theatre. Other mild side-effects may include diarrhoea and a burning sensation when passing urine (known as cystitis). If you have experienced these side-effects from your radiotherapy, then this should not get any worse. Side-effects can continue up to two weeks after your treatment is complete. We would advise you to drink plenty of fluids to minimise the effects and if they persist you can contact the Brachytherapy team, Gynaecology Nurse Specialist or GP.

Late side-effects

The treatment can cause inflammation and dryness of the vagina. The vaginal walls can lose elasticity leading to the narrowing of the vagina and this can make sexual intercourse and internal examinations difficult or uncomfortable.  To help prevent this, vaginal dilators and/or regular gentle sexual intercourse is recommended. The Brachytherapy Radiographers will discuss this in detail and answer any questions or concerns you may have.

Contact Numbers

If you need to speak to a member of staff regarding your appointments, please ring the Radiotherapy Booking Office. Any other queries regarding your brachytherapy, please contact a member of the Brachytherapy team via Radiotherapy Reception or the Brachytherapy Suite.

Radiotherapy Booking Office        (01482) 461187 / 461188 / 461189

Radiotherapy Reception                (01482) 461191

Brachytherapy Suite                       (01482) 461950 / 461951

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the

Information and Support Team  on telephone number: (01482) 461210 or

e-mail: Radiotherapy.Info@hey.nhs.uk

Useful Numbers

Please find below the contact details of useful organisations that provide information about cancer including radiotherapy treatments:

Cancerbackup and Macmillan Cancer Support

Provide information from specialist nurses on all aspects of cancer and its treatment, and on the practical and emotional aspects of living with cancer.

Free phone help line: 0800 8001234 (Monday – Friday 9:00am – 8:00pm)

Online: www.cancerbackup.org.uk

Write to: 3 Bath Place, Rivington Street, London, EC2A 3JR

PALS (Patient Advice and Liaison Service)

Provide confidential advice and support you may require about the care we provide, guiding you through the different services available from the NHS.

Telephone: (01482) 623065 (Monday – Friday 9:00am – 4:00pm)

Email: pals@hey.nhs.uk

Macmillan Sexuality Counsellor

For queries or to arrange an appointment please contact Oncology Health Centre, Queen’s Centre, Castle Hill Hospital,

Telephone: (01482) 461232 / 461060

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.