Brachytherapy in the treatment of uterine cancer
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Endometrial (uterine) cancer is usually diagnosed in women over 55 years old. In 80% of cases, it is endometrioid adenocarcinoma – a severe, resistant to treatment, prognostically unfavorable type of cancer. In the best cancer centers in the world, doctors successfully cope with this malignant tumor. Not only do surgery, and chemotherapy help in the treatment of this pathology, but also brachytherapy, as it is the safer type of irradiation as compared to the standard external beam radiation therapy.
Content
- What is brachytherapy?
- Why is brachytherapy better than external irradiation?
- Brachytherapy results
- How is vaginal brachytherapy carried out?
- Brachytherapy without surgery
- How much does brachytherapy for uterine cancer cost?
What is brachytherapy?
Brachytherapy is contact radiation therapy. Vaginal brachytherapy is usually carried out. It is most commonly used for endometrial cancer recurrence prevention in the upper vagina after hysterectomy.
The essence of the method is that an applicator with a radiation source is placed inside the vagina. It looks like a tube that contains radioactive granules. Vagina receives the highest irradiation dose, less radiation penetrates the bladder and rectum.
The main two types of brachytherapy are the low dose-rate and the high dose rate brachytherapy.
Low dose-rate brachytherapy is rarely used. The radiation source remains in the vagina for 1 to 4 days. The problem with this treatment method is that all this time the woman must lie still. It not only impairs treatment but can also lead to the formation of blood clots in the veins of the lower limbs. The patient must stay in the hospital for several days.
High dose-rate brachytherapy is the main treatment option. The radiation source is inserted into the vagina for only 10-20 minutes. The procedure is performed on an outpatient basis. A woman can return home from the hospital immediately after the procedure's completion. The irradiation modes are different: more often brachytherapy is performed once a week, in some cases – daily. At least 3 sessions of contact irradiation are required for the treatment purposes achievement.
Why is brachytherapy better than external irradiation?
The main method of radiation therapy for endometrial cancer is external radiation. Nevertheless, it has many side effects, often causes complications, and impairs a woman's quality of life.
Brachytherapy has an important advantage: with comparable effectiveness in preventing local recurrences; it has a higher safety profile. Unlike external irradiation, it rarely causes such side effects as:
- Radiation cystitis (bladder inflammation)
- Radiation proctitis (rectal inflammation)
- Low level of white and red blood cells
Sometimes, brachytherapy leads to the development of radiation vaginitis. It is manifested by soreness, the formation of erosions, and ulcers, excretion of a small amount of blood. Later, vaginal stenosis (narrowing) and dryness may occur, causing dyspareunia (painful intercourse).
Brachytherapy results
In the vast majority of cases, brachytherapy in endometrial cancer is used to risk reduction of cancer recurrence in the upper vagina. Without irradiation, such a risk reaches 15%. After brachytherapy, the possibility of recurrence is reduced to 1-2%.
The efficacy of low dose- and high dose-rate brachytherapy is the same. At the same time, the high dose-rate one does not require hospitalization; therefore it is carried out more often.
Less commonly, brachytherapy is applied in the following cases:
- Before surgery, for reducing the tumor size
- In the case of an inoperable endometrial tumor – in combination with external irradiation and chemotherapy, brachytherapy can increase a woman's life expectancy
- As a palliative method – for an advanced stage of cancer, brachytherapy stops recurrent uterine haemorrhages and reduces swelling and the severity of pain
How is vaginal brachytherapy carried out?
The treatment is usually carried out 1-1,5 months after surgery. This time is sufficient for wound healing.
The treatment procedure is simple and painless. It does not require a violation of the integrity of the tissues, therefore, it is carried out without anesthesia. The patient is lying on a couch. A plastic tube is inserted into the vagina. A radiation source from a shielded container is inserted into this tube. After a few minutes, the radioactive material is returned to the container.
What does the patient feel during the procedure?
- No pain
- Clicks or other sounds are possible
- The total duration of the irradiation is about 20 minutes
- During the exposure, the medical staff leaves the room where the brachytherapy is carried out, but the doctors can see the patient, and maintain audio communication with her
After the procedure, the applicator is extracted from the vagina. Brachytherapy usually causes such side effects as redness and swelling. Mild soreness and a small amount of blood from the vagina are possible. Burning sensations during urination are less common.
Brachytherapy without surgery
Doctors treat inoperable uterine tumors with brachytherapy. It is combined with other therapies, most often with external beam radiation and chemotherapy. If the treatment is successful, cancer can become resectable and is removed subsequently during surgery.
The treatment begins with external irradiation. The uterine and pelvic lymph nodes are irradiated. Then brachytherapy is performed.
The contact irradiation procedure is performed under general anesthesia. The following preparations are carried out for brachytherapy:
- At least 6 hours of fasting
- Rectal enema
- Low-fiber diet a few days before the procedure
The doctor inserts a catheter into the bladder and dilates the cervix. The applicators are inserted into the uterus and tumor through tubes and hollow needles. The procedure is performed under ultrasound guidance. The applicators are sometimes sutured to avoid their displacement. If necessary, the position of the applicators is checked with the help of an X-ray examination. If it is correct, radioactive material is inserted into them for a few minutes. The entire procedure takes up to half an hour.
How much does brachytherapy for uterine cancer cost?
If you use the services of Booking Health, you can book brachytherapy for cervical cancer at a favorable price. The cost of the procedure varies in different countries and hospitals. We can arrange a trip for treatment to the best cancer centers in the world. The cost of brachytherapy and chemotherapy, which are usually applied simultaneously, is shown in the table below.
| Country | Average treatment cost |
|---|---|
| Germany | 37,990 EUR |
| Turkey | 36,070 EUR |
| USA | 49,500 EUR |
| Israel | 50,010 EUR |
| Switzerland | 39,500 EUR |
| South Korea | 38,240 EUR |
When comparing the cost of medical programs in different countries, one should consider treatment success rates. Thus, hospitals with high 5-year survival rates in patients with uterine cancer may offer treatment at a higher cost. As a rule, this is connected with the regular updating of equipment and investment in doctors' training. As a result, the higher initial cost of treatment significantly reduces the costs of subsequent supportive and symptomatic therapy. Germany is the leader in terms of the ratio of price and quality of medical services in uterine cancer treatment.
You can use the services of Booking Health to undergo endometrial cancer treatment abroad using brachytherapy. We provide the following services and benefits:
- Selection of the clinic whose doctors specialize in brachytherapy and perform this procedure as effectively and safely as possible
- Booking the appointment on the convenient dates
- Direct communication with a doctor
- Reduced costs for medical services due to avoiding coefficients for foreign patients
- Preparation of the program without repeating previously performed examinations
- Help in buying and forwarding medicines
- Communication with the hospital after treatment completion
- Organization of additional diagnostics, treatment, or rehabilitation after brachytherapy
Booking Health provides TOP-class services. We will book hotel and airline tickets for you, meet you at the airport and take you to the hospital by car.
Choose treatment abroad and you will for sure get the best results!
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova, Alexandra Solovey. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
Source:
National Center for Biotechnology
WHO - World Health Organization
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