What is brachytherapy for gynecological cancer patients?
Cancer, Women's Care
LCRP Radiation Oncologist Dr. Joshua McKenzie explains this common treatment process used to treat endometrial, cervical and vaginal cancers
More than 2,000 women in Georgia are diagnosed with gynecological cancers of the reproductive tract each year. No woman is immune to the risk of gynecological cancer and that risk only increases with age.
If you or a loved one are diagnosed with a gynecological cancer, such as endometrial, cervical or vaginal cancer, there are several treatment options to help you get back to the things you love most. 
If, for example, you are diagnosed with endometrial cancer, surgery is the preferred approach to treatment, says Dr. Joshua McKenzie, radiation oncologist at the Nancy N. and J.C. Lewis Cancer & Research Pavilion. For those that can’t have surgery, your healthcare team may recommend a combination of external beam radiation therapy and brachytherapy or just brachytherapy. Your healthcare team may also recommend brachytherapy, external beam therapy and/or chemotherapy even after surgery to ensure the cancer is gone, Dr. McKenzie says.
Related Article: Understanding endometrial cancer treatment options
For vaginal cancer, as another example, most are treated with a combination of chemotherapy, external beam therapy and brachytherapy. Similarly, those diagnosed with cervical cancer (stage two or higher and some stage one), will have reduced side effects utilizing external beam therapy and/or brachytherapy instead of surgery, Dr. McKenzie says.
But, what exactly is brachytherapy?
“Basically, brachytherapy is Greek for short or close therapy. We put a radioactive source close to or within what we are treating,” Dr. McKenzie explains. “We’ve known for decades brachytherapy is critically important to treating certain gynecological cancers.”
Dr. McKenzie has utilized brachytherapy for gynecological cancer patients the entire 10 years he’s been with the Lewis Cancer & Research Pavilion. That averages to about 100 to 150 gynecological cancer patients each year who receive this specialized treatment, making the LCRP the largest volume and most experienced center for GYN brachytherapy treatment in the region, he says.
So if you are diagnosed with certain gynecological cancers part of your treatment most likely will include what’s called high-dose rate brachytherapy. There is low-dose brachytherapy, but that’s mostly used to treat prostate cancer.
High-dose rate brachytherapy delivers radiation doses at higher rates so it doesn’t take as long to deliver, typically meaning shorter treatment sessions for patients. Brachytherapy is a minimally-invasive, typically pain free treatment session done right at the LCRP.
The team at the LCRP will develop your treatment plan before your first session. That will include which device (such as vaginal cylinder or tandem and ovoid) is used to place the radioactive source either near or within the tumor and how much radiation you need.
When it’s time for your treatment, your healthcare team will use image-guided technology, combining MRI and CAT scan images, to tailor the dose to as focal an area as possible to reduce the volume of normal tissue exposed to radiation and reduce side effects while preserving cure rate, Dr. McKenzie says.
You will be hooked up to a small machine called a remote afterloader that contains the radioactive source. That machine delivers the radioactive source – which is smaller than a grain of rice, Dr. McKenzie says – to the device placed in or near the tumor. It stays there anywhere from three to 15 minutes and then comes back out into the machine, Dr. McKenzie explains.
“We then unhook everything, remove everything and the patient goes home,” Dr. McKenzie says. “That is done all right here and does not require a hospital stay.”
Dr. McKenzie does add that certain patients, particularly those with cervical cancer, may need anesthesia when the device is placed. That’s done at Candler Hospital and then the patient is transported to the LCRP for treatment, but then the patient is still able to go home.
Brachytherapy treatment sessions are typically twice a week and shouldn’t take longer than two to three weeks to complete.
“When you talk about cervical cancer especially, but also some vaginal and some endometrial cancers, the brachytherapy component is critically important,” Dr. McKenzie says. “It has shown to improve overall survival. You can’t get away just doing it all external beam. The chances of the cancer all going away go down significantly.”
And while your survival rate goes up with brachytherapy, you also are less likely to have side effects. For the vast majority of endometrial cancer patients, the side effects are minimal, Dr. McKenzie says. For some cervical cancer patients, there is a risk of short-term side effects to the bowel or bladder function, but brachytherapy allows for less risk for permanent side effects.
Nor are you considered radioactive. “Because the radioactive source is there temporarily, you are not radioactive and not at risk to anyone else,” Dr. McKenzie says.