Brachytherapy cylinder treatment to the vagina
Consultants Dr Alex Stewart, Dr Sharadah Essapen
This type of treatment is used if you have already had surgery to remove the uterus and cervix (a hysterectomy). It can be used on its own or in combination with external beam radiotherapy (EBRT). Most patients receive 2 treatments if used with EBRT and 4 if used on its own. If you are to receive this type of procedure you will be able to attend on your own and drive yourself home afterwards if you choose to.
You will be collected from the Windsor lounge and brought to the HDR suite for the procedure. You’ll be asked to change into a gown and remove some clothing. Two Radiographers and your Consultant will be present at the procedure. Prior to the treatment your Consultant will examine you to ensure it is safe and appropriate for you to go ahead with the treatment.
In order to deliver the treatment a small plastic cylinder (applicator) will be inserted into the vagina. You will be able to feel it inside you, but it should not be painful. Unless there is a medical reason not to, we will apply some local anaesthetic jelly to the cylinder to make the procedure more comfortable. The applicator will then be attached to the HDR machine ready for your treatment to be delivered. At this point some X-ray pictures will be taken to ensure the applicator is in the correct position. Everything is now ready for you to have the treatment.
You will be told exactly how long the treatment will take. An average treatment time is around 10 minutes. The radiographers will leave the room but they are able to see you all the time and are always close by if you need them. When the machine is switched on you may feel a slight vibrating sensation, but other than that the procedure should be completely painless.
Once the treatment is complete your Consultant will remove the applicator, and you can go home. The whole procedure usually takes around 40 minutes from start to finish.
Full Insertion Technique
Consultant Dr Alex Stewart
This is generally used for cervix cancer as a boost after external beam radiotherapy to the pelvis, although occasionally it may be used in other situations. You will meet with the specialist radiographers several days before the procedure to explain what will happen on the day of treatment. When that day arrives you will be admitted onto the ward at either RSCH or the Nuffield Hospital. Your anaesthetist will see you before the procedure and answer any questions you may have. You will be brought down to the specialist theatre within the Radiotherapy Department at St Luke’s for the procedure.
Most patients have a spinal anaesthetic with sedation during the procedure. This is a good choice as it gives excellent pain relief throughout the procedure. If it is not possible for medical reasons to give you a spinal anaesthetic then we may offer you injections and/or ‘gas and air’ as additional pain relief if you should require it.
In the operating theatre you will be examined and a small tube (tandem) is inserted into the cervix with some circular plastic applicators (ovoids) next to it, so that the treatment can be delivered through this to the cervical area. Occasionally some plastic tubes are placed into the ovoids so that a more sculpted treatment can be delivered to the cervix. We use ultrasound scanning during the procedure to ensure that the applicators are in the correct place. This is a technique that ensures accuracy that is not used in many centres so is innovative. The brachytherapy that we deliver is state of the art with image guidance to ensure that the applicators are in the correct position and 3 dimensional treatment planning to give you a personalised highly conformal treatment delivery. You will usually be asleep during the surgical procedure and the CT scan then gently wake-up in the recovery area where you will rest while lying flat for approximately one hour before returning to the treatment room for treatment delivery and applicator removal. You can eat and drink if you choose to during the rest time.
The whole procedure will take approximately 4 hours from start to finish. Depending on how you feel it may be possible to go home that evening, but you may choose to or need to stay overnight.