Brachytherapy is performed through the vagina for gynecologic cancers, or in other words, cancers originating from the female reproductive system.
Vaginal brachytherapy with tandem implants performed immediately after external pelvic curative radiotherapy aims to eradicate the tumor and decrease the risk of recurrence in follow-up. Vaginal brachytherapy with tandem implant (a cylindrical device) employed to decrease the risk of recurrence in vaginal cuff in endometrial cancer can be performed alone or immediately after external pelvic radiotherapy depending on stage of the disease.
Duration of brachytherapy may vary depending on location of cancer and features of other treatments that were already given. Brachytherapy is performed through the vagina for gynecologic cancers, or in other words, cancers originating from the female reproductive system. It cannot be given on daily basis, since the doses of radiotherapy per session are higher comparing to external radiotherapy.
The planned doses are divided into 3 to 5 fractions. The planned scheme is completed with 1 or 2 sessions a week. The patient is prepared for each session in a special brachytherapy room under hygienic conditions quite similar to operating theatre conditions. Vaginal implant (tandem, ovoid, cylinder etc.) is selected according to diagnosis and stage of the cancer and they are placed inside the vagina. Planning images are acquired with MRI and/or CT to deliver the planned dose to the target cancer tissue, but to protect healthy neighboring tissues, such as urinary bladder and anus. Doses are evaluated based on these images. The planned dose is delivered to the target tissue using the equipment placed inside the vagina. It is a pain-free procedure. The patient stays alone in brachytherapy room during the treatment and observed by the treatment team outside the room using a camera system. The procedure lasts for 20 to 40 minutes depending on features of the modality.
The equipment that was placed inside the vagina is removed after the session; since no radiation source remains inside the body, the patient does not emit radiation and can resume usual activities of daily life. Follow-up period starts when all sessions are completed. Patients are recommended follow-up visits at quarterly intervals for the first two years, semi-annual intervals for 2 to 5 years and annual intervals for disease-free patients after the 5-year follow-up.
Pelvic examination and smear test (obtaining a smear sample from vaginal stump or cervix) are a part of the follow-up process. The patient should be warned about treatment- and/or age-related narrowing and dryness of vagina to perform and facilitate the examination. Patients are allowed to maintain a regular sex life. However, necessary recommendations are made by brachytherapy nurses and relevant physicians for the patients, who cannot maintain sex life, to prevent vaginal narrowing that can hinder the pelvic exam.
