Intracavitary Radiation Treatments for cancer of the cervix

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Intracavitary Radiation Treatments for cancer of the cervix, vagina or endometrium (see how the radiation dose looks AP and lateral)

If the patient has not yet had a hysterectomy it is sometime necessary to include 'internal' radiation. So after completing some radiation from the outside (external beam irradiation with a linear accelerator) the woman will be admitted to hospital and have a tube inserted into the uterus (the tandem) and round applicators (ovoids) that are place on the sides of the cervix.

The tubes (or applicators) are hollow and the actual radioactive substance (cesium tubes) are slid into the applicators after X-rays and computer studies have determined the proper loading. The applicators are typically left in place for 24 - 48 hours and the woman has to remain in hospital until they are removed. The typical scenario is described below:

Generally the woman is first treated with external beam irradiation (with or without chemotherapy.) This generally takes 5 and half weeks (28 - 33 treatments.)
The assuming the cancer has shrunk down small enough that applicators can be inserted properly...she will be admitted to hospital (this is usually down 1 - 2 weeks after finishing the external beam irradiation)
The woman is taken to the operating room and under general anesthesia the uterus is dilated enough the accommodate the appropriate applicators and they are secured in place with a roll or two of iodiform gauze and often one stitch is used to ensure that the tubes are secure
When the woman wakes up (the whole procedure rarely takes more than 30 minutes) she goes from recovery room to the cancer center where X-rays are taken to determine the position of the applicators relative to the cancer (called point A) to the nodes (point B) and to the rectum and bladder
A computer plan is run to determine the best location, number and strength of the radioactive tubes to ensure that a high enough dose hits the cancer but the dose the bladder and rectum are kept below a level that can cause complications
The woman goes back to her room and then the doctor comes up and slides the radioactive tubes inside the applicators
The woman can roll side to side in bed but should not get up and try to move. A bladder catheter has been placed so she doesn't need to urinate
The computer plan determines how many hours the tubes are left in place and when the time is up the applicators can be removed (which is done in the room, with minimal discomfort)
The woman then goes home and follows up in the clinic

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