Intracavitary Brachytherapy for Gynecologic Cancers – Vaginal Cylinder

What is brachytherapy? 

Brachytherapy is a form of radiation treatment where a source of radiation is put inside your body. This allows a higher dose of radiation to directly reach the area where the tumor is or was before surgery. In the case of brachytherapy for gynecological cancers, it reduces radiation exposure to the surrounding healthy tissues, such as the bowel and bladder. Brachytherapy is administered after the placement of an applicator. An applicator helps guide where the treatment will be delivered. 

In the treatment of gynecological cancers, brachytherapy may be given in addition to traditional external beam radiation. How often you receive brachytherapy will be determined by your care team. Ask your providers what your schedule will look like before starting treatment. 

What is a vaginal cylinder?

Vaginal Cylinder

The radiation needs to be placed near your cancer or where the cancer was removed. To be able to do that, applicators are used. One type of applicator that can be used is a vaginal cylinder. This is often used in women who have had a hysterectomy. A vaginal cylinder is made of plastic and looks like a large tampon with a hollow center. It is placed into the vagina and may be kept in place with gauze, balloons, or a special undergarment. 

How is the brachytherapy administered?

Before your brachytherapy treatment, the vaginal cylinder will be placed by a provider. You will be asked to lay down on a table and place your feet in stirrups as you would for a gynecologic exam. Your provider may do a short exam and the cylinder will be placed in the vagina. You may feel pressure while the cylinder is in place. If you are very uncomfortable you should tell your provider. There are different sizes of cylinders and you may need a smaller size. An X-ray may be done to check the placement of the cylinder. 

Before starting treatment, you will need to have a simulation or planning appointment. This may be done before starting treatment or on your first day of treatment. During this appointment, after the cylinder has been placed, your radiation oncologist may place a “marker” (this may be a large-Qtip soaked in contrast solution or a fiducial seed) into the top of your vagina. This will help guide where the radiation needs to go. You will have imaging studies done such as MRIs and CT scans. 

After the imaging studies have been done, it can take your team a few hours to plan your treatment. This is because your team needs to precisely identify the area on your body where you will receive radiation. During this time you may need to lay flat or with your head only slightly elevated. 

To start treatment, you will be asked to lay in the same position you were in during your imaging tests. Positioning is extremely important in radiation therapy and your body will be positioned carefully in order to get the best radiation treatment. You will be in the same position during every treatment. Once in position, the cylinder is connected to a machine that automatically feeds a radiation source into the applicator, where it remains for a predetermined time, known as the dwell time. It is important to lie still during your whole treatment. Once the time is up, the machine removes the source and the applicator can be removed from your vagina. The radiation treatment time varies. 

Keep in mind that you will be by yourself in this room as the brachytherapy is being delivered. This is to protect the staff from the effects of the radiation. Make sure that you have no needs before the therapy starts and that you are comfortable. You will be able to talk with the therapists the entire time and if you have any emergent needs you should tell them. The therapists will be monitoring you during treatment from the cameras in the room.

How is the applicator removed?

Once your treatment is complete a provider will remove the vaginal cylinder. It is removed after each treatment and you will be able to go home shortly after your treatment is complete. 

What can I expect after the treatment?

• You may have vaginal discharge after the applicator is removed. You can use a pad but should not use tampons to manage the discharge. This can be pinkish in color and should not last for longer than a few days.
• You may experience cramping, similar to menstrual cramps, for 24 hours after the procedure. You may use ibuprofen (Advil, Motrin, or Nuprin) or naproxen (Aleve or Naprosyn) to relieve the cramps. Be sure to follow the instructions on the bottle.
• Some patients experience diarrhea. You can take over-the-counter medications, such as loperamide (Imodium) or Kaopectate to help manage any diarrhea. See our managing diarrhea teaching sheet for other tips on managing diarrhea.
• It is suggested that you refrain from sexual intercourse during treatment because of the tenderness and irritation you may have in your vagina.
• You will be given vaginal dilators to use once your treatment has been completed. These will help the vaginal tissue remain flexible, making intercourse more pleasant, but also making pelvic exams more comfortable. You will need to use the dilator for the rest of your life. See our teaching sheet on dilators to learn more about them.
• You are not in any way radioactive after the procedure and it is safe for friends and family to be around you.
• You may eat a normal diet and carry on your normal activities while on brachytherapy treatment.

Reasons to call your care team:

• You develop a fever (temperature > 101).
• You have pain that is not relieved with over-the-counter medication.
• You have excessive bleeding (more than a menstrual period) or develop a vaginal discharge.
• You have burning or blood in the urine more than 24 hours after the procedure.
• You do not have a bowel movement for 3-4 days after the procedure.
• You have more than 3-4 episodes of liquid diarrhea a day.

The process and techniques used to deliver brachytherapy using a vaginal cylinder can be very specific to the center where you are receiving your therapy. Do not hesitate to ask questions regarding your care.