Brachytherapy: Lighting the Way Against Cervical Cancer

Brachytherapy is a form of targeted radiation therapy that has become a beacon of hope for many patients battling cervical cancer. This advanced treatment option allows high doses of radiation to reach cancer cells directly, sparing healthy tissues and reducing side effects.

For patients diagnosed with cervical cancer, understanding brachytherapy and its benefits can make a significant difference in their treatment journey. This guide explains what brachytherapy involves and what to expect.

Learn more about cervical cancer symptoms, screenings, and treatment options in our comprehensive guide to cervical cancer.

What is brachytherapy?

Brachytherapy is a specialised form of internal radiation therapy where radioactive material is positioned directly within or near the tumour. In cervical cancer treatment, it allows for a high concentration of radiation to target the tumour precisely, reducing exposure to nearby healthy tissues like the bladder and rectum. This approach is especially effective for localised cervical cancer and is often combined with external beam radiation therapy (EBRT) and sometimes chemotherapy to enhance treatment outcomes.

This treatment is especially effective in controlling localised tumours in the early stages of cervical cancer. It can also be used in combination with external radiation and chemotherapy to improve outcomes in advanced cases. The ability to customise radiation levels and positioning makes brachytherapy a unique option in the fight against cervical cancer.

Learn more about gynaecological cancer management here.

Types of brachytherapy 

There are two main types:

• High-dose-rate (HDR) brachytherapy: Delivers stronger radiation doses over shorter periods, typically 10-20 minutes per session.
• Low-dose-rate (LDR) brachytherapy: Delivers lower radiation doses over 24-48 hours, requiring a hospital stay.

How is brachytherapy performed?

Brachytherapy for cervical cancer comes in two main types: low-dose-rate (LDR) and high-dose-rate (HDR), differing in how long and how intensely radiation is applied. Here’s how it works:

1. Preparation

   • Before starting, imaging techniques like ultrasound, CT or MRI scans help pinpoint the exact tumour location. To make the procedure comfortable, patients usually receive anaesthesia or sedation.

2. Placement of applicators

   • Special devices, known as applicators (tubes or cylinders), are gently positioned within the vagina and cervix. Sometimes, small needles are also inserted around the tumour to ensure radiation reaches all areas evenly.

3. Radiation delivery

   • Delivery of radiation through the applicators

4. After the procedure

   • Once the brachytherapy session is complete, the applicators are carefully removed, and the patient is monitored briefly before going home. Follow-up appointments are essential, as they help assess the treatment's effectiveness and allow the healthcare team to manage any side effects.

Side effects and complications of brachytherapy

While brachytherapy is an effective treatment for cervical cancer, patients may experience some short-term and long-term side effects due to radiation exposure. Understanding these potential effects can help in managing symptoms and seeking timely support.

Short-term side effects of brachytherapy

These effects are generally temporary and may occur during or shortly after treatment:

• Vaginal irritation: 

  • Many patients experience mild soreness, discharge, or spotting after brachytherapy sessions. These symptoms typically improve with time.

• Bladder and bowel discomfort: 

  • Radiation can cause irritation in the bladder and bowel, resulting in symptoms like frequent urination, diarrhoea, or general discomfort in the abdominal area.

• Fatigue: 

  • Fatigue is common with most forms of radiation therapy, including brachytherapy, and may persist for a few weeks after treatment concludes.

Long-term side effects of brachytherapy

Long-term side effects may develop months or even years after treatment. While less common, they can sometimes be more challenging to manage.

• Vaginal stenosis

  • Radiation may cause the vaginal tissue to become narrower or less flexible, leading to discomfort during sexual activity. To help prevent this, doctors may recommend the use of vaginal dilators.

• Bladder and bowel complications

  • In some cases, long-term radiation exposure can lead to conditions like radiation cystitis (inflammation of the bladder), resulting in frequent urination or blood in the urine. Radiation proctitis, which affects the rectum, may cause persistent bowel issues.

• Lymphedema

  • Damage to lymph nodes during treatment can sometimes lead to swelling in the legs or lower body, known as lymphedema.

• Fistulas

  • In rare cases, radiation can cause abnormal openings, or fistulas, between the vagina and nearby organs such as the bladder or rectum, which may require further medical intervention.

When is brachytherapy recommended for cervical cancer?

Brachytherapy is a standard and highly effective treatment for certain cases of cervical cancer, especially in locally advanced stages (stage IB2 to IVA). This targeted therapy is usually recommended in the following situations:

1) Primary treatment for advanced localised cervical cancer

For patients with cervical cancer that hasn’t spread beyond the pelvic area (stages IB2 to IVA), brachytherapy is used alongside external radiation (EBRT) and chemotherapy. This combination helps target the cancer more effectively, focusing the treatment directly on the tumour while protecting nearby healthy tissues.

2) After surgery as a follow-up treatment

If someone has early-stage cervical cancer and undergoes surgery, brachytherapy may be recommended if there are certain high-risk factors, such as cancer cells near the edge of the removed tissue (positive margins) or cancer found in lymph nodes. This extra step reduces the chances of the cancer returning.

3) Recurring cancer in the pelvis

For cases where cervical cancer has returned and remains confined to the pelvis, brachytherapy can be part of a salvage therapy plan. This approach targets recurrent tumours with precision, aiming to control localised cancer growth effectively.

Advancements and benefits of brachytherapy

Recent advancements in brachytherapy technology have greatly enhanced its precision and effectiveness, making treatment safer and more comfortable for patients. Here’s how these innovations benefit those undergoing brachytherapy:

• Image-guided brachytherapy (IGBT)

  • With MRI or CT scans guiding the procedure, doctors can ensure the applicator is placed precisely, which allows for highly accurate radiation delivery directly to the tumour. This imaging approach helps concentrate the treatment on cancerous cells while protecting healthy tissue nearby.

• Customised treatment plans

  • Using real-time imaging and monitoring, oncologists can tailor radiation doses based on the tumour’s response. Adjusting treatment as needed allows for the best possible outcome by increasing the tumour’s exposure to radiation without increasing side effects.

• Organ-sparing techniques 

  • Newer brachytherapy methods focus on protecting surrounding organs, like the bladder and rectum, from high-dose radiation. These techniques make treatment more targeted, reducing the risk of complications and improving the patient’s quality of life.

Where to get brachytherapy in Singapore?

Brachytherapy has revolutionised cervical cancer treatment by offering a safe, effective, and targeted solution. As a standard treatment for cervical cancer, brachytherapy provides excellent tumour control with minimal risk to surrounding tissues. For many patients, this option offers hope for a cancer-free future with fewer side effects and a quicker recovery than conventional radiation therapy alone.

Choosing the right treatment can make a significant impact on your journey with cervical cancer. Thomson Medical’s specialists are committed to providing comprehensive support throughout your treatment journey, helping you navigate available options and developing a personalised treatment plan tailored to your unique needs. To discuss your options further, request an appointment with us today.

FAQ

What is the success rate of brachytherapy?

Brachytherapy is highly effective for cervical cancer, especially when combined with external radiation therapy and chemotherapy in locally advanced stages. Studies indicate that local control rates, or the ability to contain the cancer within the pelvic area, range between 70% and 90%, depending on factors such as the cancer stage and patient health.

For patients with early-stage cervical cancer, the five-year survival rate can be as high as 90% when brachytherapy is included as part of the standard treatment. While survival rates may be lower for more advanced stages, brachytherapy greatly enhances outcomes by delivering high-dose radiation directly to the tumour, lowering the risk of recurrence. Additionally, the use of modern imaging techniques, such as MRI or CT scans, during the procedure has improved precision, further increasing treatment success.

What is the patient experience and recovery like with brachytherapy?

Most patients tolerate brachytherapy well. With high-dose-rate (HDR) brachytherapy, sessions are typically brief, allowing patients to return home the same day. In contrast, low-dose-rate (LDR) brachytherapy involves longer exposure to radiation, which may require a short hospital stay for careful monitoring.

Pain or discomfort following the procedure is usually mild and can be managed with prescribed medications. Patients are generally encouraged to rest after treatment and gradually resume normal activities as they feel comfortable. Regular follow-up visits are essential to monitor recovery, evaluate the tumour’s response to treatment, and manage any potential side effects. These visits help ensure optimal outcomes and allow healthcare providers to address any concerns during the recovery period.

Is brachytherapy painful?

The procedure itself is generally painless, as it is performed under local or general anaesthesia, so patients typically do not feel discomfort during the placement of the radioactive sources. However, some mild soreness or discomfort may occur afterward, depending on the area being treated. Any post-procedure discomfort is usually manageable with medication and subsides in a short period.

Is brachytherapy safe?

Brachytherapy is considered a safe treatment option with a low risk of radiation exposure to others. In temporary brachytherapy, the radioactive material is removed from the body after each session, leaving no residual radiation. In permanent brachytherapy, the radiation levels diminish significantly over time, making it safe for patients to be around others after treatment.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a specialist at Thomson Medical. Book an appointment with Thomson Medical today.