Brachytherapy

Internal radiotherapy (brachytherapy) is often given after external radiotherapy. Tubes are placed into your vagina through your cervix and into your womb. A radioactive capsule is placed in the tubes.

If you’ve not had a hysterectomy, you’ll have intrauterine brachytherapy. Your doctor will place tubes into your vagina, through your cervix and into your womb while you’re sedated or under a general anaesthetic.

If you’ve had a hysterectomy you’ll have intravaginal brachytherapy. A tube will be placed in your vagina. You will not need an anaesthetic.

The tubes will be connected to a machine that delivers a radioactive capsule into them.

The most common way to give brachytherapy to the cervix is as a high-dose treatment. It is given on a number of occasions and takes a few minutes. Less common ways are low- and pulse-dose rate treatment.

Image-guided brachytherapy (IGBT) uses MRI or CT scans to make radiotherapy very accurate. It is not available throughout all of the UK. If it’s a suitable treatment for you, your doctor can arrange for you to have it at a different treatment centre.

Internal radiotherapy

Internal radiotherapy is called brachytherapy. It gives radiation directly to the cervix and the area close by. It’s usually given following external radiotherapy.

How you have your treatment will depend on whether or not you’ve had your womb removed. Having brachytherapy involves having a tube or tubes put into your womb or vagina. The treatment is then given through the tubes.

Position of tube applicators for brachytherapy
Position of tube applicators for brachytherapy

View a large version

Read a description of this image


Intrauterine brachytherapy

If you’ve not had a hysterectomy, you will have intrauterine brachytherapy. Your doctor will insert hollow tubes (called applicators) into your vagina and pass them up through your cervix into your womb. Sometimes additional applicators are placed alongside the cervix. The applicators are inserted in an operating theatre while you’re sedated or under a general anaesthetic.

Occasionally a spinal anaesthetic may be used – your doctor will be able to tell you more about this. To help protect your back passage (rectum) and prevent the applicators moving, a pack of cotton/gauze padding may be placed inside your vagina. You will also have a catheter put into your bladder to drain off urine.

The applicators can be uncomfortable, so you may need to take painkillers.


Intravaginal brachytherapy

If you have had a hysterectomy, a single, larger, hollow tube applicator will be placed in your vagina. You won’t need an anaesthetic or sedation to insert the applicator and padding isn’t necessary.


How you have your treatment

You’ll have an MRI scan, CT scan or x-rays to check the position of the applicators. Once it’s confirmed that the applicators are in the correct position, they are connected to the brachytherapy machine. The machine is operated by the radiographer and delivers a radioactive capsule, called a source, into the hollow tubes. The machine is programmed so the source gives off the correct dose of radiation.

You may have your treatment as an inpatient or outpatient depending on how it’s given.

  • High-dose rate treatment gives a high dose of radioactivity over a few minutes.
  • Low-dose rate treatment gives a low dose of radioactivity over a few days.
  • Pulsed-dose rate treatment gives treatment in short bursts over a few days.


High dose treatment

This is the most common way of giving brachytherapy to the cervix. You have treatment as a high dose of radioactivity over a few minutes. You will have several treatments. How high-dose rate treatments are given varies from hospital to hospital. Usually your treatment takes about 10–15 minutes.

You may stay in hospital and have your treatment on a number of occasions over several days. The applicators are usually removed between treatments, but sometimes they’re left in place and removed after your final treatment.

Alternatively, you may have your treatment as an outpatient or day case on three or four occasions over several days or a week. If you have your treatment as an outpatient, the applicators will be removed before you go home. A plastic tube may be left in your cervix to help your radiotherapy team position the applicators for your next treatment.

You may have a tube (catheter) put into your bladder to drain urine during high-dose rate treatment. This will be removed before you go home.


Image guided brachytherapy (IGBT)

If you have high-dose rate treatment you may have image guided brachytherapy (IGBT). IGBT makes the radiotherapy very accurate. It uses CT or MRI imaging to pinpoint exactly where your cancer is before each treatment. This makes it possible to shape the radiation dose to match the shape of the tumour and to avoid organs such as the bowel and bladder. Sometimes additional applicators may be used to boost the dose of radiotherapy to a particular area.

IGBT that uses MRI images is particularly accurate but it isn’t available everywhere in the UK. The Royal College of Radiologists and the Department of Health recommend that women with cancer of the cervix should be offered MRI-based IGBT from 2015.

Your doctor can tell you whether IGBT is a suitable treatment for you. They can arrange for you to have IGBT at another treatment centre if it’s not possible for you to have it at your local one.


Low dose treatment

Low-dose rate treatment is used less often. You will normally be in hospital for 12–24 hours, but sometimes you may need to stay for a few days. Your doctor, nurse or radiographer will tell you more if you are going to have low-dose rate treatment.


Pulsed-dose rate brachytherapy

If you have this treatment the applicators stay in place for the same length of time as low-dose rate treatment, but the radiation dose is given in pulses rather than as a continuous dose. Your doctor, nurse or radiographer will give you more information if you are going to have pulsed-dose rate treatment.

Back to Internal radiotherapy explained