Brachytherapy

Radiation Therapy

Phyllis. So sorry you have to go through this. But we have all been there. And you're right. Everyone's experience is different. I can only tell you mine. I had Stage 3c, Grade 3 endometrial cancer. Hysterectomy followed by 14 out of 18 weeks of chemo. I had a stroke that ended my chemo. I had 28 days of external radiation which was mentally more difficult for me than chemo. I had a lot of nausea because I had to have the radiation high because of one lymph node. The combo of radiation and probably steroids during chemo caused an insufficiency fracture of my sacrum.   I also had 3 sessions of internal therapy. The after effects I've suffered are frequent bladder infections and burning (which I think I've solved with vitamin e suppositories). I am plagued with very tight pelvic muscles for which I am seeking pelvic floor physical therapy and I hate the dilator!   All this has made sex totally impossible and I'm not sure that will ever improve but I'm working on it. 

I don't say this to scare you. You may not have any problems. The point is that you must do anything you can right now to SAVE YOUR LIFE! Your best chance is to prevent a reoccurrence. If it comes back, it's harder to treat. No matter what side effects you suffer you have to have the perspective that it's better than being dead. That's my opinion 

Radiation

Was the cancer penetration greater than 50% in the lining (endometrium) or myometrium (uterine muscle)?

Knowing the difference is important to your decision because penetration of the muscle as opposed to the lining greater than 50% and cervical involvement and/or origination of the cancer in the lower uterus are factors that up the risk for recurrence even with a lower grade/stage of cancer. It is why the radiation they are recommending for you is considered the standard of care when those factors are present. Lymph node involvement is also a factor, but it doesn't sound like you have that issue.

Lower Uterine/Cervical involvement ups the risk that cancer cells were shed into the vaginal cuff area and may not have been removed by surgery alone. The radiation is an insurance policy that increases your odds of remaining NED, but unfortunately does not guarantee cure. I think that uncertainty and the risks of Pelvic Radiation Disease is why we are all question the risk/benefit of subjecting ourselves to it when it's recommended for our treatment plan. What you read on the internet about Pelvic Radiation Disease is truly hair raising stuff and I don't blame your doctors for cautioning you against reading it. You have to remember it's like all of the drug commercials you hear on TV. They are giving you all of the possibles, but it doesn't mean that you'll necessarily experience them.

There are different types of delivery methods for radiation that are available and you should try to familiarize yourself with them so that you can ask your radiation oncologist what he plans to use on you and why. There's EBRT (external beam radiation therapy); Brachtherapy (internal); IMRT (intensity-modulated radiation therapy), IGRT (Image Guided Radiation Therapy); RAPIDARC (Volumetric Modulated Arc Therapy); Respiratory Gating; SRS (Stereotactic Radiosurgery..used for brain cancer); SBRT (Stereotactic Body Radiotherapy), 3D-CRT; Electron Beam Therapy (used for skin lesions and cancer node sites); and fractionation.

Not all kinds delivery methods are available at all radiation centers or are appropriate for all types of cancers or are covered by insurance. I would have preferred the IGRT, but it's exponentially more complicated to deliver and therefore more expensive and wasn't covered by my insurance. The 3D-CRT is very similar and the closest alternative to that.

I had whole pelvic radiation using 3D-CRT (conformal radiation therapy) that spared surrounding organs to the extent possible by shaping the rays to a narrower area and had an external vaginal "boost" rather than brachytherapy. My understanding is that the two achieve the same effect but the brachytherapy is delivered internally while the boost is given externally. The worst side effect for me has been constipation rather than diarrhea like the majority seem to experience.  I finished RT last December and it's still an issue, but I'm coping with it relatively well and that actually may be residual nerve damage from the chemo and the radiation just exacerbated it.

Two things that seem to help a lot of us during radiation is being sure to drink plenty of water daily and taking a good probiotic like Culturelle. Other than that, there'll probably be fatigue and diarrhea or constipation and that varys in degree from individual to individual. Plan to give yourself time to rest. It seemed like my blood work (RBC, WBC, etc.) took longer to recover from radiation than it did for chemo; that may account for the fatigue. 

Good luck with what you have facing you, I know it's scary thinking of the possible risks of the RT, but you have to weigh those against the risks factors for recurrence that you know you have. Now is the best opportunity you have for a cure; this cancer is a lot harder to get rid of if it comes back so you want to give yourself the best chance possible.

brachy

Phyliss, I breezed through 5 brachys - not one side effect! However, I credit it all to my radiation oncologist and his staff. His mom was a RO and she certainly taught him well. Talk to your provider and be honest about all your fears. If he/she is worth their salt, they will guide you through it. I had a terrible experience with the oncology group with my chemo so was not going to do the brachy, but one hour with my RO and I went for it. I hope the same for you.