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High Dose Rate Brachytherapy with Syed for Patients with Gynecological Cancers

This information will help you prepare for high-dose radiation (HDR) brachytherapy with afterloading catheters, including what to expect before, during, and after your treatment.

Introduction

Radiation therapy is a treatment for some cancers. One way to give radiation is to place a radioactive source inside the body. This is called brachytherapy. The source is placed in or near the tumor. You will be getting high dose rate (HDR) brachytherapy delivered through a Syed system of catheters. These catheters will be placed in the operating room. You will be admitted to the hospital and will stay for four days.

Most patients also get external beam radiation therapy (EBRT). That treatment is described in a separate booklet. The HDR treatments begin about a week after the EBRT is completed.

The standard treatment schedule is getting EBRT for 5 days every week in weeks 1 to 5. Then,  you will have 4 days of HDR treatments in week 7. 

Preparation

  • Your doctor's office will schedule the HDR treatment and tell you the date. Someone will call you the day before to tell you what time you must arrive and where you must check in.
  • If you develop a cold, fever, flu-like symptoms, or a rash, call your doctor as soon as possible. We may have to reschedule the treatment.
  • Review the booklet called Getting Ready for Surgery. It provides important information about how to prepare for the operating room.
  • Review the fact card Common Medications Containing Nonsteroidal and Anti-inflammatory Products. It lists medications that have aspirin and non-steroidal anti-inflammatory medicines (NSAIDs). Stop aspirin 5 days before you are admitted to the hospital. Stop NSAIDs 24 hours before you are admitted.
  • You will meet with someone from the brachytherapy team about one week before admission. He or she will review the details of the procedure with you.
  • You will also have a presurgical testing (PST) appointment. You will see a nurse practitioner (NP) and a patient care technician. Please bring a list of all medications that you take. Include prescription and over-the-counter medications and herbals. The NP will review them with you and tell you what to take on the days you will have HDR treatment. You will have routine blood tests, an electrocardiogram, and a chest x-ray.
  • By the time you start your treatment, you may have diarrhea from your external beam radiation therapy. However, we still want your bowel to be fairly empty of stool the day of your treatment. Follow the instructions below on how to change your diet the day before the procedure.

The Day Before You Are Admitted

  • Take your usual medications
  • Eat a light breakfast
  • Start a clear liquid diet (see below) after breakfast and continue it all day and evening up until midnight
  • To prevent dehydration and a feeling of weakness, have at least eight to ten, 8-oz servings of liquids
  • Do not have anything to eat or drink, including hard candy or chewing gum, after midnight

 

Food Category

You May Have

You May Not Have

Soups

  • Clear broth or bouillon
  • Clear consommé
  • Any other soups

Sweets and Desserts

  • Gelatin
  • Flavored ices
  • Honey, sugar, sugar substitutes
  • Hard candy
  • Any other sweets or desserts

Beverages

  • Water
  • Clear fruit juices, such as apple, cranberry, or white grape, Kool-Aid®
  • Gatorade®
  • Black coffee or tea (in limited amounts, no more than 2 cups)
  • Juice with pulp or nectars
  • Carbonated drinks or soda, such as ginger ale, 7-Up®, Sprite®, seltzer, cola
  • Alcoholic beverages
  • Milk or cream

The Morning of the Procedure

You may have to give yourself a Fleet® enema before the procedure. Your nurse will let you know if you need this. If you do, give it to yourself first thing in the morning. Follow the instructions on the package.

Take a shower before you come to the hospital. You may brush your teeth, but do not swallow the water. Do not have anything to eat or drink. Take your usual medicines, except those for diabetes, with a small sip of water.

Do not wear any makeup or nail polish. You will need to remove glasses, hearing aids, and dentures if you wear them. Bring cases for them so they will be safe. Do not wear contact lenses.

Go to the Pre-Surgical Center (PSC), 1275 York Avenue. Take the escalator to the 1st floor, then take a B elevator to the 6th floor.

The Syed Procedure

Positioning of the Catheters and Treatment Planning

You will be taken into the operating room. You will be given sedation to make sure you are asleep and have no discomfort. You will be lying on your back with your legs raised. A catheter will be placed into your bladder to drain urine. A number of catheters will be placed through your vagina and into your uterus and cervix. Your doctor will decide how many catheters are needed based on the size of the area that is to be treated. The catheters will be held in place by a template. This is a small square piece of plastic with many holes in it. The template will be secured between your legs, sutured to your thighs.

After the catheters are placed, you will be brought to the recovery room. When you wake up you will have an intravenous (IV) in place through which you will receive pain medicine. Nurses will monitor you for about one hour. Once you are fully awake, you will be taken to have a computed tomography (CT) scan to check the placement of the catheters. The doctor can adjust their position, if necessary. The CT scan will take about 20 minutes. For some patients, the CT is done while you are still under anesthesia. Your treatment team will also use the CT scan to plan your HDR treatment. After the scan is completed, you will be taken to your hospital room.

While in the Hospital

While the catheters are in place you must stay in bed. You will be lying on your back with your legs straight. You can have the head of the bed up only 30 degrees. You cannot move your hips or legs, but you can wiggle your toes. You can also move your arms and upper body. Compression boots (also called SCDs) will be placed on your legs. These boots will be connected to a machine that pumps air in them from time to time to help the blood flow in your legs.

You will receive pain medicine through your IV. You can control it yourself. This is called patient-controlled analgesia (PCA). Your nurse will show you how to give yourself extra pain medicine when you need it. You will be asked to do deep breathing exercises using an incentive spirometer throughout the time you will be in the hospital. You will have all your meals in bed. You will have a urinary catheter draining urine from your bladder. You will be given a low-residue diet and medicine to prevent you from having a bowel movement. Some patients prefer not to eat food that makes them bloated or produces gas, as this makes them uncomfortable. Use your call bell if you need help; it will be anchored to your bedside.

Lying still and flat in bed for 4 days is difficult. Since you will be in bed at all times, bring materials that will help you pass the time. You may bring books and magazines, a radio, DVDs, cards, or board games. While you are in your hospital room there is nothing radioactive in these catheters. You may have visitors and do not have to be alone.

Treatment

You will receive 4 to 5 treatments while you are in the hospital. The first will be given the evening of your first day in the hospital. It is given in the Department of Radiation Oncology. The radiation therapists will attach the catheters coming out from your vagina to cables. These look like long, plastic straws. They are connected to a machine that stores the Iridium. The therapist will call out numbers. This is to make sure that each catheter is connected correctly.

Once everything is set, you will be left alone in the room to receive treatment. The room has a video camera and an intercom. Staff can see and hear you at all times. The iridium will be moved through the cables into the catheters. It is left in your cervix for 10 to 20 minutes. You will not feel any pain or discomfort while the iridium is in place. You will not see or feel the radiation. You may hear the machine humming when it is turned on. After the treatment is done, the iridium is moved back into the storage machine. The therapist will come back and disconnect the cables. You will then be taken back to your room.

The remaining treatments will be exactly like the first. You will have them twice a day. Each treatment is about 6 hours apart.

After the Last Treatment

The template and catheters are removed. You will then be brought back to your hospital room. You will be discharged home the next day. You may feel some uterine cramping and pressure in the vaginal area. These symptoms go away over a couple of hours. Ask the nurse for medicine to relieve them if you are uncomfortable.

After Your Discharge

  • You can go back to your usual diet.
  • You are not radioactive from the treatment. You may have contact as you wish with other people.

Possible Side Effects And How To Manage These

The following side effects are possible after HDR brachytherapy treatment:

  • You may have cramping for a day. Ibuprofen (Advil®) or acetaminophen (Tylenol®) can help.
  • You may have vaginal spotting or bleeding. It should not be more than you have with a monthly period. You can use pads, but do not use tampons or douche.
  • The vaginal or anal area may become irritated. Sitz baths with plain warm water will be soothing. You can buy a plastic sitz bath at a drug store. It fits into your toilet. You can also fill a tub with warm water. Sit in the water for 15-20 minutes and repeat as needed for your comfort.

You may have side effects for 4 to 6 weeks after treatment is done. Your nurse will tell you how to care for yourself and review the booklet Radiation Therapy to the Pelvis for Gynecologic Cancer. Call your doctor or nurse if you have:

  • Vaginal bleeding that is more than light spotting
  • Cloudy or foul smelling urine
  • Blood in your urine
  • Fever greater than 100.4º F (38º C)
  • More than three watery bowel movements a day that are not relieved by medicine
  • No bowel movement in three days
  • Rectal bleeding
  • Nausea or vomiting and are not able to keep food down
  • Abdominal or pelvic pain that does not go away after you take your pain medicine