Brachytherapy / Gynaecological HDR (High Dose Rate)

Northern Centre for Cancer Treatment

Introduction

You are going to have internal radiotherapy also known as Brachytherapy or high dose radiation (HDR) for your cancer. This leaflet explains what you can expect. 
We hope it answers some of the questions you may have. Please tell us if there is anything you don’t understand. We are here to take care of you and we don’t mind how many questions you ask!

What is Brachytherapy (HDR)?
 
Brachytherapy is a type of radiotherapy, which is given internally (inside the body). The machine uses a high dose of radiation, which is why it is known as HDR. Brachytherapy can be used as the main treatment or as part of a combination of treatments that may include surgery and external beam radiotherapy.
 

How is the treatment given?

Brachytherapy is given at the radiotherapy department at Newcastle General Hospital, which has a special room for this treatment. You will need to lie on a bed for the treatment. 
A tube called an applicator is inserted into your vagina. The applicator is held in place by a small corset. The applicator is connected to a machine using a long tube. The machine can then deliver treatment to you internally through the tube. The treatment is not painful but the applicator may be a little uncomfortable.

Each treatment lasts approximately 5-10 minutes (plus five minutes to insert the applicator). Treatment times vary for individuals and are worked out by your consultant for you. 

You will need to have this treatment on two separate occasions usually at least 48 hours apart. You will be able to attend as an out-patient and go home when the treatment is over.
 
What happens when the treatment finishes? 

The machine switches off automatically when the treatment has finished. The nurse will remove the applicator and corset. This is a quick and simple procedure. It does not usually hurt. Once the applicator is removed you can sit up. 

What happens next? 

You can go home when the staff are happy that everything is well. You will be sent an appointment to see your consultant in an outpatient clinic about 6-8 weeks after you have finished all of your treatment. After this you will be seen approximately every 3 months for a couple of years. At the appointment the Doctor will ask questions about how you are feeling, he/she may need to do an internal examination. Occasionally you may need to have a blood test or scan but this does not happen routinely. If you have any questions please ask, we are here to help you.
 
What are the potential after effects?

 For most women these effects are short term but occasionally some women may develop long-term bowel, bladder or vaginal problems.
Please speak to your Nurse Specialist or Doctor about this. 
The after effects of this treatment are the same as external beam radiotherapy to your pelvis.

•  Bowel 
  The treatment may cause diarrhoea this may last for a few weeks. Changing your diet or taking medication can help this. We also advise that you drink lots of fluids. If symptoms persist contact your GP or your Specialist Nurse for advice.
   
•  Bladder
  The treatment may cause some irritation when passing water. You can help this by drinking plenty of fluids. Your urine may be cloudy or smelly this is often a sign of infection. You may need some medication if it does not get better. If symptoms persist contact your GP or your Specialist Nurse for advice. 
   
•  Pain/discomfort
  You may get some cramp like pain. Taking mild painkillers and warm baths often helps this. If the pain does not improve contact your doctor. You may have some vaginal irritation or soreness. Regular bathing and using a lubricant such as KY jelly or Replens can relieve this (these can be bought at the chemist). Do not use any other creams unless you have asked your team as these may make the soreness worse. If symptoms persist contact your GP or your Specialist Nurse for advice.
   
• Fatigue 
  You may find you feel tired. This is quite normal and we advise you to rest during the day as often as you can if you need to. Return to work when you feel ready. Light exercise can also help to improve fatigue such as walking.
   
•   Vaginal discharge/bleeding 
  You may have a slight discharge following the treatment this is normal. If the discharge persists, or is smelly or pale green/yellow, report it to your doctor, as it may be an infection. To reduce the risk of infection bathe regularly, wear cotton pants and avoid wearing tight trousers or tights. 
   
•  Vaginal scarring
  The risk of this is slightly more following Brachytherapy. The nurse will speak to you about this and give you information about vaginal dilatation. If you wish she will also discuss any possible difficulties with sexual intercourse. 
   
•  Feelings 
  Reactions following treatment differ from person to person-there is no right or wrong way to feel. These emotions are part of the process that people go through in trying to come to terms with their illness. You can contact your Specialist Nurse if you would like someone to talk to or the other sources of information listed below.

Useful Contacts:

Janet Pickering 
Gynae Oncology Nurse Specialist 
0191 2563295 or 0191 2663131 bleep 1780

Other sources of Information 

Miss V. Lockey
Cancer Information Centre
Northern Centre for Cancer Treatment
Newcastle General Hospital
Tel: 01910256 

CancerBACUP
A registered charity providing information and support for cancer patients and their families 
Telephone: 0808 800 1234
www.cancerbacup.org.uk 

Information produced by Alison Featherstone 
Gynae-Oncology Nurse Practitioner
April 2004, Review Date April 2006