Treatments and Technology

High Dose Rate Brachytherapy for Gynecological Cancer


Overview


Endometrial and cervical cancers remain very prevalent in our society. In fact, uterine cancer is the most common cancer of the female genital tract in the United States and cervical cancer remains the number one cause of female cancer mortality worldwide. Thankfully, the incidence of cervical cancer has decreased greatly in countries where routine PAP smears are commonly performed. Despite these advances, we are still treating many patients with these types of cancers. Brachytherapy is a key component in the treatment of both cervical and endometrial cancers.

HDR Brych for GynacBrachytherapy is a critical component in the treatment of cervical and endometrial cancers. Brachytherapy is a type of radiation therapy where a radioactive source is placed close to the tumor or area of interest. Because of a woman’s anatomy, there is a unique opportunity to use this type of treatment. This opportunity allows us to deliver a high dose of radiation to the tumor or area of interest while minimizing radiation dose to normal tissues. This treatment opportunity translates into great success in the treatments of cervical and endometrial cancers. There are two different types of brachytherapy, low dose rate(LDR) and high dose rate(HDR). These treatments differ in the amount of time required to deliver the desired dose to the tumor or area of interest. High dose rate(HDR) brachytherapy has been the preferred form of brachytherapy in the setting of endometrial cancer for some time. For cervical cancers, HDR brachytherapy has become the preferred form of brachytherapy since it does not require hospitalization, limits radiation exposure to hospital personnel, and has similar outcomes when compared to low dose rate brachytherapy.


Treatment for cervical cancers may include surgery, radiation therapy, chemotherapy or some combination of these modalities. HDR Brachy for Gynac2 Treatment recommendations will be made by your doctor after the proper evaluations have been made. However, cervical cancer is often treated with combined chemotherapy and radiation therapy. Radiation therapy will likely include external beam radiation therapy and brachytherapy. Either low dose rate or high dose rate brachytherapy may be performed although high dose rate brachytherapy is preferred for the reasons above. For cervical cancers, HDR brachytherapy is delivered using applicators called tandem and ovoids or tandem and ring. Before receiving brachytherapy for cervical cancer, the patient will be taken to the operating room for placement of a small tube (cervical stent) into the cervical portion of the uterus. Following cervical stent placement, the patient will present to the radiation oncology department where the applicators will be placed. The tandem will be placed into the uterus where the cervical stent is located. Then, the ring or ovoids are placed next to the cervix where the tumor is located. Following placement, the applicators are connected to the HDR machine where a radioactive source (Iridium 912) is located. When the treatment is initiated, the radioactive source will quickly travel into the tandem and the ring where it will deliver the prescribed dose of radiation to the tumor.  Once the treatment is done, the applicators can be removed quickly and the patient can continue her day. Patients will require four to eight treatments of this type when undergoing treatment for cervical cancer. After all of the treatments are complete, the radiation oncologist will remove the cervical stent without another trip to the operating room. The treatments are generally well tolerated and do not require hospitalization.


HDR Brachy for Gynac#Endometrial cancers are primarily treated with surgery. However, some patients require additional treatments such as radiation therapy and or chemotherapy. Radiation therapy is used after surgery to help reduce the risk of recurrence in the areas of the vaginal cuff or pelvis. If radiation therapy is required, it may consist of external beam radiation therapy, brachytherapy or a combination of both of these treatments. High dose rate (HDR) brachytherapy is most commonly recommended in this setting. If brachytherapy is recommended, a treatment device called a vaginal cylinder is utilized to deliver the treatment. A vaginal cylinder is similar to a large plastic tampon with a central channel. After placement of the vaginal cylinder into the vagina, the cylinder is connected to the HDR treatment machine where the radioactive source (Iridium 192) is located. After the connection is made, the treatment will be initiated. The radioactive source will travel quickly into the central channel of the cylinder to deliver a high dose of radiation to the top of the vagina.  After the treatment is complete, the vaginal cylinder is disconnected and removed from the patient. The treatment process takes about an hour and most patients will require three treatments. After the treatment is complete, the patient can continue with her day as the treatment is extremely well tolerated.

Brachytherapy for gynecologic malignancies is a very important part of successful treatment for these cancers. Our physicians have special training in the treatment of female malignancies and can provide you with the best care possible. We encourage you to contact us for an appointment so that we can answer any additional questions you have about brachytherapy or the treatment of gynecologic malignancies.

 

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