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Brachytherapy

brissance's picture
brissance
Posts: 192
Joined: May 2016

Hi Ladies of the Sisterhood of Kicking Uterine Cancers Arse (LoS KUCA),,  Dumb but looking for levity..  I must say I have really really benefited from all of you and your straight forward manner in dealing with the evil one, cancer, your answers based on first had experience and your continue "faith" in yourself and each other.  Pretty awe inspriing.    

I am fairly new to this world.  Had my girlparts removed in Feb after DX stage 1a/grade3..  I have done 3 rounds of chemo (sort of), just starting second week of external radiation.  So far I have had the normal ups and downs but have actually had minimal problems.  I have been extremely fortunate.  

After my 25 external radiation treatments, I am scheduled for brachy but not like I have seen any of you discuss and wonder if any of you could shed light on my treatment.  I am getting 3 continuous days.  I will have the tube placed in a surgery setting, then the tubes and I will be placed into a room where the radioactive material will be remotely inserted into the tubes *low dosage.  I will have to remain sedimentary for 3 days.  Husband and daughter may only see me 3 x  day for 10 min limit.  I will have a catherter and pre treatment purging and diet I should not have a bowel movement for the three days.  I probably can't do the computer but can watch tv.  

Anyway, I have seen lots of info on brachy but it is a short burst 3 or 4 days, not in hospital.  Has anyone had their treatment in ths manner and any insight?  I am at a great hospital and the proton/radiological department is well known and respected (Loma Linda in California).   

I will let you know if I glow in the dark after treatment.  May be a nice way to get past or electric bills!

TeddyandBears_Mom's picture
TeddyandBears_Mom
Posts: 1734
Joined: Jun 2015

Wow! That is quite different than anything I have heard of. I think I've read just about all of the posts here for quite a while and I don't remember anyone describing this type of radiation. I had the "standard" brachy spread over 5 sessions instead of the usual 3. All done within a two week timeframe.  I wonder if this is a new approach to prevent tissue damage? Did your docs say anything about that?

I hope this goes well for you. And that the time passes by quickly.

Love and Hugs,

Cindi

Editgrl's picture
Editgrl
Posts: 903
Joined: Jun 2015

One of my radiologists talked about this.  It's a type of low-dose radiation as opposed to the HDR brachytherapy that most of us have.  I do understand that it is being used less frequently these days, but don't know what the thinking is when it comes to choosing between the two methods.

debrajo's picture
debrajo
Posts: 1095
Joined: Sep 2011

I had the old standard five treatments, Monday, Wed., Friday, then Monday and Wendsday.  Took all of about five minutes.  No external radiation.  One of the treatments fell on a chemo day, so took the radiation early in the morning and the chemo in late morning and then drove myself home after an eight hour infussion.  Wishing you the very best.......I didn't glow in the dark, but I lead everyone to think I might be "active" so the husband slept on the couch! LOL!

MoeKay
Posts: 313
Joined: Feb 2004

Hi brissance, I had low dose brachytherapy 17 years ago shortly after completing five weeks of external radiation.  It's been a long time, so my memory has faded, but I believe mine was two full days in isolation.  I do recall getting kind of anxious having to lay somewhat flat for the duration.  I forget what the angle was that the bed could be elevated, but I'm thinking somewhere around 30 degrees.  I do remember that I told everyone not to visit, even though they could have stayed in the room a short while behind a shield.  Instead, I spoke to relatives and friends over the phone. 

I know the experience wasn't too bad, because what I remember most was that after getting out of the hospital, I went to the pharmacy to pick up a prescription, and while I was there, someone sideswiped the whole side of my car, which had me more upset than anything having to do with the brachytherapy! 

Best of luck to you.

brissance's picture
brissance
Posts: 192
Joined: May 2016

What luck...  your car was side swiped.  Sort of Rosanna Danna, "If it is not one thing it is another".  Hope I fare as well as you did.  Thanks for the input.  :)

EZLiving66's picture
EZLiving66
Posts: 1467
Joined: Oct 2015

When I daughter had thyroid cancer she had swallow a radioactive pill that was laced with iodine so it would be attracted to the thyroid cancer that had spread.  She was in the hospital for about three or four days and I could only visit her once a day for a short time behind the "lead line."  The entire room was covered in plastic including the bathroom and when she got out of the hospital she was supposed to stay at home and away from small children, babies and pregnant women for at least a week.  

It must have worked because she went almost 20 years before they found another tumor in her neck which they removed and found it hadn't spread.

Good luck to you!!!

Love,

Eldri

brissance's picture
brissance
Posts: 192
Joined: May 2016

My sister in law did that pill too for an over active thyroid.  She had to sleep alone for a while, couldn't hold her grandbabies... etc but she came through it with flying colors.  The pill passes through and dies.  Mine will have active for the time I am there and then they remove it.  Thanks for the good wishes.. right back at you.

 

Kaleena's picture
Kaleena
Posts: 2053
Joined: Nov 2009

I had the 3 brachytherapies HDR (High-Dose Radiation) treatments.   I went one time a week for three weeks and like Debra it only took 5-10 mintues after the initial setup (which took about 45 minutes).   I couldn't do external treatments because I was already pretty scarred up from the endometriosis.  My best to you.

Kathy

Soup52's picture
Soup52
Posts: 906
Joined: Jan 2016

I had the standard 3 internal and 5 weeks of external. I do remember the dr. Talking about the the type of brachytherapy you are having in the hospital, but I don't know how they decide who gets what type. Unfortunately the radiation has done a number on my digestive system which my oncologist said may always be with me. Not a happy thought:( 

brissance's picture
brissance
Posts: 192
Joined: May 2016

When  I have weekly meeting with my Radiological Dr. I will ask..  didn't think of it before. The literature pretty well echoes what you all have posted so I am a bit in the dark as to why the 3 day treatment.  I know there are patients sent here from other states for the same treatment, met a few the first day of radiology.  Getting ready to get "zapped" by external on day 5 of 25 days..  so far not too bad.. had touch of the scoots and touch of tippy tummy but not enough to complain.  Think I am getting off pretty easy.  :)

Kvdyson's picture
Kvdyson
Posts: 789
Joined: Jan 2016

Brissance, when I had external radiation a daily probiotic helped limit the tummy side effects for me. You may want to check with your rad-onc to see if they might help you, too?

 

brissance's picture
brissance
Posts: 192
Joined: May 2016

Appreciate this.. have increased the probiotics and you are right, it has helped on the tippy tummy syndrome.

Kvdyson's picture
Kvdyson
Posts: 789
Joined: Jan 2016

Brissance, so glad to hear that increasing the probiotics helped! How are you doing otherwise?

brissance's picture
brissance
Posts: 192
Joined: May 2016

All is wonderful.. no complaints.  Just finished #14 of 25 radiation.  During chemo and radiation I have had 5 abscesses (boils) most have just been bothersome. (There are testing me for staff MRSA etc)  This Thursday had one on my bum and Friday saw Onc and he sent me to the emergency room...   16 hours later I emerged sans infection in my posterior.   But what a pain to keep clean from infection...  as the diarrhea has hit at this time.  Can't use tape as the radiation has really sensitized the area...  so basically I am on a continual sitz bath regime.  Worse part is my family has shown no mercy in their teasing me...  I am the "butt" of the jokes.  So bottom line ...  I am fine.. having the routine ouches and issues but nothing overly serious.  Thank you so much for asking.  I certainly hope all is well with you.

SandyD's picture
SandyD
Posts: 130
Joined: Oct 2015

3 treatments over a 2-week period. Like others the treatment was brief and really not bad at all. Like you I'm stage 1A, grade 3. This is the first time I've heard about this treatment variation. Wonder if there are some advantges? I'll be interested in what you find out. It's been not quite 2 weeks since I finished the brachytherapy and the only effects I've noticed is a minor burning sensation from time to time and feeling pretty tired for a while.

brissance's picture
brissance
Posts: 192
Joined: May 2016

Spoke to radiological doctor yesterday and she said that the treatments both have pretty much the same results and dangers.  She gave a number of examples.  Basically the facility prefers/uses the low dose (mulitple days mine is 3 days and 2 nights).  She was willing have me do the other but recommended the low dose.  So I talked to my oncology gynecologist and read what I could and I am going ahead with the low dose treatment.  I will let you guys know.  Not thrilled about the immobility for 3 days and 2 nights.  But like it better than uterine cancer spreading.  Easy decision to make on that level. Still have 16 days left of external radiation so will fight that dragon at it approaches.

Patty

ConnieSW
Posts: 1545
Joined: Jun 2012

If all things are equal, I don't understand why they are opting for low dose.  I had it and it was the worst experience of my life, much worse than surgery and chemo.  I'm not a wuss and  I'm good at solitude and entertaining myself so I thought it would be ok.  I took books, magazines, music, iPad, knitting, phone and, of course, the room had a tv.  I wasn't able to concentrate at all so the iPad, phone and music were the only helpful items.  I couldn't even manage the 30 deg elevation without the thing slipping so just used 2 pillows.  Lying on my side didn't work either.  I put a positioning pillow on each side and used them to cant myself slightly.  You sorta do that to eat with the tray next to you in the bed but I didn't eat much.  The food was low residue so you won't have a bm  and was very unappealing.  I didn't want to make staff come in any more than necessary so I kept my toothbrush and toothpaste within reach and brushed when I had my breakfast and after supper.  That's also when I asked for a towel and wet washcloth to wipe my face and hands.  Having no hair to deal with was a good thing.   I was already having problems staying asleep and used Ativan for that but it didn't help much.  I've never seen a clock move so slowly.  The second day I broke down and started taking  the prn Ativan I had ordered during the day ( something for me because I avoid pills as much as I can) and that made it bearable.  The last day I told the radiologist when he came in the am to not even think about being one minute late that afternoon.  Bless his heart, he was 5 minutes early.

I really thought long and hard about posting this because I don't want to upset you but finally decided that being honest and frank about our experiences is what this site is all about.  So, my advice is, make sure you have an Ativan order.

 

i do have a funny story.  They kept my bathroom door locked.  Someone once  forgot she was on bed rest and took herself to the toilet.  The cylinder fell out and they had to search the hospital plumbing to find it.  Oh, dear.

brissance's picture
brissance
Posts: 192
Joined: May 2016

I will definitely look before I flush..  thanks for the smile.   

TeddyandBears_Mom's picture
TeddyandBears_Mom
Posts: 1734
Joined: Jun 2015

Connie, so glad you posted. I was wondering the same thing. If this is an older way and the results are the same, why put someone through the 3 days?  Because the HDR was so "easy" in comparison. In and out with very limited issues. Just some fatigue. 

Patty, did your radiologist say why she preferred the low dose?

I know you will make the best decision for yourself.

Love and Hugs,

Cindi

MoeKay
Posts: 313
Joined: Feb 2004

As I posted above, I too had the low dose brachytherapy in 1999, although only for two days, not three.  Admittedly, my memory has faded about the particulars, but I do recall quite a bit of anxiety towards the end of the treatment.  What's got me curious, though, is as Connie mentioned above, if all things are equal, why are they choosing to use the three-day, inpatient option?  At the time I was treated, I was not offered the high dose, outpatient option, but if it's true that all things are in fact equal, I would choose the shorter treatment option. 

Given my curiosity, I did a little research, first on the ACS website for endometrial cancer.  Here's what it says about the two types of brachytherapy:

  • In LDR brachytherapy, the radiation devices are usually left in place for about 1 to 4 days. The patient needs to stay immobile to keep the radiation sources from moving during treatment, and so she is usually kept in the hospital overnight. Several treatments may be necessary. 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 is less commonly used now in this country.                                                                                                                                                                                     
  • In HDR brachytherapy, the radiation is more intense. Each dose takes a very short time (usually less than an hour), and the patient can go home the same day. For endometrial cancer, HDR brachytherapy is often given weekly or even daily for at least 3 doses.           

I then looked for studies that compared the use of LDR to HDR in the treatment of endometrial cancer.  Interestingly, most of the studies I saw were on cervical cancer.  The following is an abstract of the only study I was able to find comparing the two types of brachytherapy for endometrial cancer:

Int J Radiat Oncol Biol Phys. 2007 Feb 1;67(2):480-4. Epub 2006 Dec 4.

Comparison of high-dose-rate and low-dose-rate brachytherapy in the treatment of endometrial carcinoma.

Abstract

PURPOSE:

To compare the outcomes for endometrial carcinoma patients treated with either high-dose-rate (HDR) or low-dose-rate (LDR) brachytherapy.

METHODS AND MATERIALS:

This study included 1,179 patients divided into LDR (1,004) and HDR groups (175). Patients with International Federation of Gynecology and Obstetrics (FIGO) surgical Stages I-III were included. All patients were treated with postoperative irradiation. In the LDR group, the postoperative dose applied to the vaginal cuff was 60-70 Gy surface doses to the vaginal mucosa. The HDR brachytherapy prescription was 6 fractions of 2 Gy each to a depth of 0.5 cm from the surface of the vaginal mucosa. Overall survival, disease-free survival, local control, and complications were endpoints.

RESULTS:

For all stages combined, the overall survival, disease-free survival, and local control at 5 years in the LDR group were 70%, 69%, and 81%, respectively. For all stages combined, the overall survival, disease-free survival, and local control at 5 years in the HDR group were 68%, 62%, and 78%, respectively. There were no significant differences in early or late Grade III and IV complications in the HDR or LDR groups.

CONCLUSION:

Survival outcomes, pelvic tumor control, and Grade III and IV complications were not significantly different in the LDR brachytherapy group compared with the HDR group.

Brissance, if it were me, I would explore the issue further with my radiation oncologist to find out why she believes the low dose brachytherapy is the better option.  Although the statistics reported above were somewhat better for the low dose, it appears that the differences were not statistically significant.  It sounds to me like there is still a missing piece to this puzzle. 

Good luck and good health to you!

                                                                                                                                                                                    

ConnieSW
Posts: 1545
Joined: Jun 2012

about asking more questions and the missing piece.  

brissance's picture
brissance
Posts: 192
Joined: May 2016

First, let me apologize to Cindi, MoeKay, and Connie for not thanking you sooner for your info.  Connie you mentioned you were worried about posting...  I am glad you all did.  I would hate to think I made a critical decision without actually weighing all the information (that would make be eligible to run for political office...  another joke and non partisan.. it applies to all of them.)  I used your info and the info I followed up with on my own and had a great discussion with my Oncologist.  

He has worked at hospitals that only provided high dose, one that had high and low and one (this hospital) that can provide both as well as proton therapy (which can serve as a highly sophisticated HD radiation alternative).  He did tell me right off that he would help arrange high dose if after the discussion it was still my desire to seek high dose.  Here is a quick and probably not 100% perfect rendention of his reasoning.  (I wound up in the emergency room for 15 hours that day for a darn abscess of the perianal region and it was a fright.. but fine now.)  I have been enduring being the "butt" of my family's jokes.

The doctor agreed with most of my/our studies and I asked if a toss up why did he prefer low dose?  He stated that he felt I would have a "long" life after this bout.  He was concerned with after effects..  High dose has not been around that long 10 to 15 years to actually develop "good" information on the post treatment effects..  LD has been over 50 years and he feels that the "studies" are quite positive.  Low dose also allows for correction.  If there is a "movement" etc, in LD you can make a correction w/ minimal damage as it is monitored closely.  With HD, the dose is so strong that damage is usually more devastating when the accidents happen...  and I guess they do.  I told him my reading indicated that HD looked more accepted as a "best treatment" and also mention I had spoken to you guys...  

He did disagree w/ HD being more affective he believe medical studies "leaned" in favor of Low Dose.  The immobility, discomfort and blood clots were an issues.  He believed that all of these issues are outweighed by the positive of LD.  I am healthy (well, use to be), 1A with wash showing 5% UPSC and DVT concern will be very closely monitored.  He said it comes down to comfort v the most affective treatment.  He would recommend that his wife or his mother receive LD if the issues were the same.   So both he and my oncological Radiologist and the review board believe the most advantageous therapy for my circumstances will be LD.. but  if I want to change to HD, they will change the orders immediately.  My call.  Husband and I, unless other info is received, have opted for the LD..  I sure hope I am right as I do not have a lot of patience and will go crazy..   

He was honestly quite pleased that we had the conversation and I had facts not emotion.  He thought the idea of the discussion board was awesome.  He questioned me about it and it effects on me..  if it helped etc. 

So bottom line (no reference to my boil/abcess) I am continuing with Low Dose..  at least I am planning at this point.  I truly thank you guys for your input.  I am convinced that I am smart enough to be involved with my own treatment decisions and your experiences and knowledge are critical for an attempt to reach the best decision. Again thanks so much

Patty

Editgrl's picture
Editgrl
Posts: 903
Joined: Jun 2015

I was wondering what the doctor's rationale was.  Good to hear that he was open to a discussion about it and willing to entertain another option if you desired. 

 

 

brissance's picture
brissance
Posts: 192
Joined: May 2016

I thank you and hope you are doing well.  
Believe me I am still reading and the jury is out..  but right now I am on schedule for the low dose. 

Patty.  

MoeKay
Posts: 313
Joined: Feb 2004

Hi Patty, I really appreciate your providing us with your oncologist's rationale for preferring low dose brachytherapy.  I was happy to see his comment that he believes medical studies "leaned" in favor of low dose, since that is consistent with the results of the one endometrial cancer study I found (included in my May 28 post).  I must admit that having been treated 17 years ago when LD was the only brachytherapy option presented to me, I was more than a little envious of the women who were able to have HD in later years when HD became more common than LD.  I thought that HD seemed like so much easier of a treatment option.   But now I realize that even if I had been given a choice between LD and HD, based on all the information you now have been provided by your treatment team, in all likelihood I would have opted for the inpatient LD anyway. 

I'm glad that your oncologist thoroughly explained the basis of his recommendation to you.  Whatever you ultimately decide, it appears that you now have a much fuller picture on the pros and cons of both options, so that you are in the best position to make a fully informed decision. 

Wishing you all the best,

MoeKay

 

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