Article on Brachytherapy

Interesting article. I did not experience any pain with my brachytherapy, I don't remember exactly but I believe I did have some sort of lubricant applied, it might have had lidocaine in it. What I did not understand is why she said she had to have anesthesia and several hours of recovery for the brachy? Why would she feel pain if she was unconscious? Maybe the article was truncated that included more information. Perhaps she had a more intense (longer, more powerful, who knows) brachytherapy?

I ask these questions because I don't remember any of our ladies telling us that they had such horrible pain when they removed the vaginal tube, and I don't also remember being catheterized. I don't want others to come here and be scared of what was an embarrassing procedure, very mildly uncomfortable, for a few minutes.

I am not questioning her account of her procedure, but it seems to me that she did not have the garden variety brachytherapy and her patient advocacy is exactly what we need as patients. Perhaps others can chime in? Anyone else have anethesthesia for a routine brachy session?

Denise

Good points, Forherself.

The patient advocacy was important, crucial and welcome. What I question is the procedure that she had done as opposed to my own procedures. It just feels like something is missing in between because why would she have had anesthesia and then horrible pain? (I don't question her story, I woke up from an emergency C-section with no pain meds because the doctor forgot to order them and I just literally started screaming in unimaginable pain when the nurse told me to stop being a baby and I was disturbing the other patients, I just continue to scream with uncontrolled pain until someone gave me the pain meds. Mind you, this was after 14 hours of unproductive labor, unsympathetic nurses and a doctor who decided to show up many hours into my labor ).

A few clarifications would help us to see what her situation was at the time.

I just don't want newbies coming here and thinking that the brachytherapy procedure was horribly painful, when I, and anecdotally others did not have that same issue. My brachytherapy was in 2018, her's in the last year. Embarrassing, a tiny bit uncomfortable, but not at all painful.

Hopefully we can get clarification from others?

Denise

Thanks for posting this interesting article, Forherself. I had low-dose rate (LDR) brachytherapy which involved spending two days in isolation in the hospital and I don't recall any significant issue with pain. It's my understanding that the current HDR outpatient brachytherapy treatments were not standard of care until a number of years after I completed treatment in 1999.

However, I have a fundamental question about a statement in the first paragraph of the article. The author states that after experiencing post-menopausal spotting, she consulted her gynecologist who performed a "cervical biopsy." I've never heard of anyone having a cervical biopsy to detect endometrial cancer. Since a cervical biopsy is a procedure to remove tissue from the cervix to test for abnormal or precancerous conditions, or cervical cancer, I'm assuming this must be a typographical error and she must have meant to say "endometrial biopsy." Or am I missing something?

Her article might have been shortened as some of these things don't quite match up, but I would guess that the different centers have different protocols. I received my 2nd opinion, and all of my post initial dx at Mayo. I had no pain, just a bit uncomfortable as they fitted me for the right cylinder, and no pain at all when it was withdrawn.

Regardless, this is very good information to know as many times we patients are not fully warned about the possible pain. Lidocaine should be offered to everyone as her experience probably is not uncommon.

Denise

I had vaginal brachytherapy 8 years ago after a robotic hysterectomy. It was not a terrible experience. I got over being embarrassed. Mostly, I've had to deal with dryness, but not horribly. When I had my first recurrence, I had external beam pelvic radiation. That was also not so bad - mostly fatiguing. For me, the biggest negative side effect was that, as a synchronized swimmer, I couldn't maintain my balance vertically in the water. But that went away about a month after radiation. For my 2nd recurrence, which was a tumor due to contamination from the original hysterectomy, I had external brachytherapy through my stomach muscle in and out of the tumor and again out through the stomach muscle. That was terrible. But that only lasted 5 days. If anyone has to get that, please contact me. I have some constructive advice for that one.

Hi NoTime,

Since LDR brachytherapy had to stay in place for such a long period of time, hospitalization and immobilization were necessary. With HDR brachytherapy, you get a higher dose, but it's only for approximately 10-20 minutes. See: https://www.cancer.org/cancer/types/endometrial-cancer/treating/radiation.html, which states in pertinent part:

"Brachytherapy:

This procedure is done in the radiation therapy area of a hospital or a radiation treatment center. There are 2 types of brachytherapy used for endometrial cancer, low-dose rate (LDR) and high-dose rate (HDR).

• In LDR brachytherapy, the applicator with the radiation source in it is left in for about 1 to 4 days. The patient needs to be still to keep the applicator from moving during treatment, so she's usually needs to stay in the hospital during treatment. 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 isn't commonly used in the US.
• In HDR brachytherapy, the radiation is stronger. Each treatment takes a very short time (usually less than an hour), and the radiation is only in for 10 to 20 minutes. The applicator is only in place when the treatment is done. You will be able to go home the same day. For endometrial cancer, HDR brachytherapy might be given weekly or even daily for at least 3 doses.

The most common side effect is changes in the lining of the vagina. (Called radiation vaginitis, this is discussed in more detail below, in the side effects section.) If needed, pain medicines can be used to help you be more comfortable while the applicator is in."

While the above American Cancer Society's website states that LDR isn't commonly used in the U.S., it was back when I was treated in 1999. Thank goodness for patient-friendly medical advances over time!