Brachytherapy

 

 

What is Brachytherapy?

 

According to cancer.org:

Women who have had their uterus (and cervix) removed may have the upper part of the vagina treated with brachytherapy. This is called vaginal brachytherapy. A source of radiation (a radioactive material) is put into a cylinder (called an applicator) and the cylinder is put into the vagina. (It feels a lot like a snug tampon.) The size of the cylinder and how much radiation is in it depend on each case. The upper part of the vagina, closest to the uterus, is always treated. With brachytherapy, the radiation mainly affects the area of the vagina in contact with the cylinder. Nearby structures like the bladder and rectum get less radiation exposure.

This procedure is done in the radiation therapy area of a hospital or a radiation treatment center. There are 2 types of brachytherapy used for endometrial cancer, low-dose rate (LDR) and high-dose rate (HDR).

• In LDR brachytherapy, the applicator with the radiation source in it is left in for about 1 to 4 days. The patient needs to be still to keep the applicator from moving during treatment, so she's usually needs to stay in the hospital during treatment. Because the patient has to stay immobile, this form of brachytherapy carries a risk of serious blood clots in the legs (called deep venous thrombosis or DVT). LDR isn't commonly used in the US.

• In HDR brachytherapy, the radiation is stronger. Each treatment takes a very short time (usually less than an hour), and the radiation is only in for 10 to 20 minutes. The applicator is only in place when the treatment is done. You will be able to go home the same day. For endometrial cancer, HDR brachytherapy might be given weekly or even daily for at least 3 doses.

The most common side effect is changes in the lining of the vagina. If needed, pain medicines can be used to help you be more comfortable while the applicator is in.

 

In my situation, I was treated with HDR brachytherapy. I was an inpatient during the treatment time as I was given an epidural and needed to be completely flat on my back for the entire duration of my hospital stay. 

 

To further explain brachytherapy for endometrial cancer:

They use a 'template' about the size of your palm. Using this template, they insert 'pins' into your vagina. These pins are approximately 1/16 of an inch in diameter and about 12 inches in length. If memory serves me correctly, they inserted 18 pins in my template. 

 

Because I had the epidural, I didn't feel anything, but I do recall the sound of them hammering in the pins.  I probably have a tiny bit of PTSD just from that. 

 

Of course, what's a hospital stay without a little bit of drama? 

The Radiation Anesthesiologist began the drug administration the evening before my initial brachytherapy treatment.  He told me that my drug was going to run out prior to my leaving for my appointment. The instructions he gave were to have the nurse call anesthesiology when it is close to running out, so they can bring more of the drug to me. 

Early in the morning, my IV machine was singing the song of its people, alerting everyone to the fact that my drug was about to run out.  I rang for my nurse so that she could let anesthesiology know.  She had little interest in doing this. My drug ran out, and the pain started to kick in.  Past experience tells me that when I am in high levels of pain, I’m not a nice patient.  I was persistent with the nurse. She finally told me that she had called anesthesiology and they had told her I should wait until I got to the cancer center for more drugs. 

Dr Miller’s nurse stopped in before my transport to the center to see how I was doing. I relayed the situation. She was not pleased at all.  The EMTs came to take me to the cancer center and the radiation anesthesiologist was upset that my drug was allowed to run out.  I told him what the nurse had said about having to wait. He was less than pleased because no one had even contacted the anesthesiology department.  Needless to say, after treatment, I was accompanied back to my hospital room and a pow wow was had with the charge nurse. Another nurse bites the dust, never to be seen by me again.

On the final day of brachytherapy, as Dr Miller was finishing up with me, the EMTs arrived at the clinic for my return to the hospital.

EMT: “Are you ready to go, Mary?”

Dr Miller: “Are we on first name basis with the patients now?”

EMT: “Shoot…. Doc… this is our third date.”

Me: “Yup. Third date. But don’t expect me to put out!”

On that note, the nurse had to leave the room because she couldnt stop laughing. 

Upon return to the hospital, Dr Miller and his nurse met up with me in recovery, where they removed the template and pins. The epidural was also removed.  I spent one more night just for observation. 

On the date of my discharge March 13, 2020,  the Governor of Idaho shut down the state due to Covid. 

 

Until next time…