Intra-Uterine Brachytherapy

  • Reference Number: HEY-036/2018
  • Departments: Oncology (Cancer Services), Radiotherapy

Introduction

This leaflet has been produced to give you general information in relation to your treatment.  Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, 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.

What is Brachytherapy?

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

What will happen?

If you have received external beam radiotherapy then your Brachytherapy treatment will not commence immediately.  You will need to be booked into the next available theatre session.  Appointments will be pre booked by our booking co-ordinators and you will be informed by post. The Brachytherapy Team will provide any additional information you may need prior to your procedure.

Whilst undergoing your external beam treatment we will arrange for you to see the ward staff to organise your admission and pre assessment for the Brachytherapy procedure.

The Brachytherapy procedure requires you to undergo a general anaesthetic to allow the applicators to be inserted.  The day before the procedure you will be admitted to Ward 30 at the Queen’s Centre, Castle Hill Hospital.  We would advise you to bring an overnight bag and any medication that you are currently taking.  Prior to your treatment we would also advise you follow a low residual diet (this will have already been explained to you prior to being given this leaflet).  You should not eat or drink after midnight on the night before the procedure.

Intra-Uterine Brachytherapy treatment is usually given in 3 treatments.  These treatments take place across 2 weeks and will require 3 general anaesthetics.

These treatments will take place over 2 consecutive weeks, an example of this can be found in the table below.

You will be admitted onto the ward the day before to your Brachytherapy treatment.

On the morning of your treatment you will be taken to the theatre at approximately 07.30am to prepare you for your anaesthetic.  Once you have been anaesthetised the Doctor will examine you and insert the applicators.

As the applicators have to stay in place until each individual treatment is completed, a catheter will be placed in your into your bladder to enable you to pass urine during this time.  The applicators will be kept in position with gauze packing; you will be able to feel the applicators between your legs.

The applicators will be connected via a small hollow flexible tube to the Flexitron.  A radioactive source will travel down the hollow tube via a thin wire and will stop at programmed points to deliver the planned treatment dose.  The Flexitron will be switched on once the Radiographers have left the room and have closed the door.  The Radiographers will communicate with you over the intercom and will monitor you via CCTV.  When the treatment is complete the Radiographers will enter the room to remove the applicators and gauze packing.

An example of a daily Brachytherapy treatment pathway

  • Theatre: anaesthetic applicators and catheter inserted
  • Recovery
  • CT scan
  • MRI scan
  • Return to Ward 30, whilst your treatment is being planned (2 hours approximately)
  • Taken to Brachytherapy Suite for treatment  (Approximately 30 minutes)
  • Removal of applicators in Brachytherapy Suite
  • Return to Ward 30 for catheter removal and discharge until next planned admission

Once your catheter has been removed you must be able to pass urine before you can be discharged.

After each treatment 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.

What happens afterwards?

 After your treatment the Radiographers will go over the possible side effects and will be able to answer any questions.  You will see your Doctor approximately 6 weeks after your treatment is complete.

Are there any side effects to the treatment?

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, this is due to the packing used in theatre.

Mild Side Effects: May include diarrhoea and a burning sensation when passing urine (cystitis).  If you have already experienced these side effects from your radiotherapy; this treatment should not make them any worse.  Side effects can continue for up to 2 weeks after your treatment is complete.  To minimise the side effects it is suggested that you drink plenty of fluids.  If the side effects persist please do not hesitate to contact the Brachytherapy Team, your Gynaecological Nurse Specialist or your GP.

Late side effects: The treatment can cause inflammation of the vagina and dryness. The vaginal walls can lose elasticity which can lead 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 with you and will answer any questions or concerns you may have.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact a member of the Brachytherapy Team who can be contacted via Radiotherapy Reception or the Brachytherapy Suite.

Radiotherapy Booking Office        (01482) 461187 / 461188 / 461189

Radiotherapy Reception                (01482) 461191

Brachytherapy Suite                       (01482) 461950 / 461951

Student Radiographers

 We are a teaching hospital, therefore it is possible we will have male and female Student Radiographers present during your treatment.  If you would prefer them not to observe; please can you make the Radiographers aware before your treatment.

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.