Several different types of treatments are used in radiation therapy. HDR (high dose rate) implants are a newer type of procedure that allows your radiation oncologist to prescribe a specific radiation dose to a specific area of the body. This type of treatment is very short in duration and usually done on an outpatient basis.
The HDR vaginal cylinder implant procedure is used to treat patients with uterine, cervical or vaginal cancer. These patients are usually treated with a course of external beam radiation therapy and a series of three to five implant treatments. The implants are usually at the end of the external beam treatment. Your radiation oncologist will discuss this type of treatment with you and what the most appropriate sequence of events is in your case during your initial consultation.
Pre-procedure
Prior to your first HDR implant you will meet again with your radiation oncologist for a full explanation of the procedure and to give you an opportunity to have all your questions answered. The radiation oncology nurse will also meet with you to review specific information regarding preparation for the procedure, the schedule, what will happen during the procedure itself, any side effects you may expect, how to minimize these and what to report to your radiation oncologist. You will have plenty of time to have any questions answered.
Procedure day
On the day of the implant, you will be asked to go to the gowned waiting room and change into a treatment gown. You will need to remove all undergarments, taking off all clothes. Then we ask that you please go to the restroom and empty your bladder and bowels, if possible. The radiation oncology nurse will come and take you to the treatment room. There you will be positioned on a gurney in the same position as you would be for a regular pelvic exam. The nurse will wash your pelvic area with a Betadine solution and then insert a catheter into your bladder and rectum. Occasionally, the radiation oncologist may inject a small amount of local anesthetic in your vagina prior to your first treatment. This may momentarily sting a little. The radiation oncologist will then insert the applicator into your vagina. This may cause a feeling of pressure and mild discomfort. After the applicator is secured, the nurse will re-position your legs on pillows and make you comfortable. It is very important that you lie still for the remainder of the time that the applicator is in place. You will then be wheeled on the gurney to the simulation room where a series of X-ray films or CT scan will be taken to verify the position of the applicator. While you return to the treatment room, the physics staff will use the X-rays or CT scan taken to create a customized treatment plan according to your radiation oncologist’s prescription. As soon as the plan is ready, you will receive your treatment.
Treatment
You will be in the treatment room approximately 10-20 minutes although you will not be receiving radiation during the entire time. The treatment is delivered by connecting small tubes to the end of the applicator that was placed in your vagina, which are connected to a machine at the other end. Once all the tubes are connected, the staff will leave the room. They will be able to communicate with you through the intercom system and will be watching you at all times via the video monitor. The machine will then be activated remotely to have small radioactive sources travel from the housing of the machine to the tip of the hollow tubes that are connected to the applicator. Once the sources have been in place long enough to deliver the treatment dose, they travel back to the machine housing. The staff will then re-enter the room and verify that the sources have all retracted and that no radiation is present. The applicator and catheters will then be removed. The nurse will review the discharge instructions with you and give you a printed instruction sheet.
Radiation safety
Radiation safety is a concern to many of our patients. No radiation is present in your body except during the applications of radiation through the tubes while in the HDR suite. Objects that you touch or items that you use are NOT radioactive. Your bodily wastes (urine and stool) are NOT radioactive. Since no radiation remains in your body, it is safe to be around pregnant women and children.
Activity
Even though you may feel well, it is advisable that you stay home from work for the rest of the day after the procedure. You should feel well enough to resume your normal activities within 24 hours.
Bladder
Minor burning on urination and frequent urination are common for the first few days after your procedure. It is important to drink six to eight 8-ounce glasses of clear fluids a day to help the bladder heal. You should avoid alcohol, acidic juices and caffeine, as they may cause further bladder irritation. If symptoms become worse, contact your radiation oncologist, who will prescribe medications to alleviate these symptoms.
Vaginal Discharge
Frequently, patients will experience light vaginal spotting or discharge for the first couple of days after the procedure. This is an expected side effect. If the discharge should become heavy or have a bad odor, or if you experience heavy bleeding that requires several pad changes, you should immediately notify your radiation oncologist as directed on your discharge instructions.
Pain and Swelling
You may have some pain and discomfort on the evening after the procedure in your perineal area. To reduce both the pain and the swelling, you may apply an ice bag to the area.
Follow-up
You will return to see your radiation oncologist approximately two weeks after your last implant procedure. This will be a good time to ask any questions you may have. It is very important that you continue seeing both your radiation oncologist and your gynecologist for regular follow-ups. They will be able to ensure that you are healing properly from your treatment and that the cancer is not returning.
During these visits you will need to have a pelvic exam. The radiation you need may cause some narrowing and shortening of the vagina due to scarring. During your first follow-up appointment, the radiation oncology nurse will give you a vaginal dilator and instructions on its use. Regular use of the vaginal dilator or sexual intercourse is essential to maintaining the vaginal opening and avoiding scarring, making it more comfortable for future gynecological exams, as well as maintaining your sexual health. You may resume sexual activity as soon as your vaginal tissues are healed and you feel comfortable. See additional information in “Vaginal Dilator Use”.
If you have any questions once you get home or in the days following your procedure, please make sure you call the radiation oncology nurse. Please follow the instructions on the discharge sheet regarding when to call the radiation oncologist to notify him of any side effects.
