Patient Information

Patient Experience: Radiation

Interstitial Brachytherapy

Interstitial catheters may be recommended for your treatment plan. Interstitial catheters are hollow narrow tubes that hold radiation and temporarily stay in the tumor during an inpatient hospital stay.

Before the interstitial procedure, an appointment will be made for you to meet with an anesthesiologist in the pre-admitting testing center approximately one week before the procedure. At the time of the pre-procedure appointment, blood tests, a chest x-ray or other radiologic imaging, an EKG or additional studies may be performed. Most patients, if eligible, receive general anesthesia before the procedure. An epidural catheter may be placed before the procedure, in order for you to adjust your pain medication during the course of your inpatient hospitalization.

You will be required not to take any food or drink by mouth after midnight the night before the procedure. You will also need to have a bowel preparation the night before the procedure.

On the day of the procedure, you should proceed first to the admitting department on the first floor. You will be directed to L2 and brought into the procedure room by the anesthesiologist, and placed under anesthesia. A foley catheter is first placed into the bladder. The interstitial applicator is then placed while you are under anesthesia. After insertion of the applicator, you will be scanned on a CT simulator, a treatment plan is generated, then treatment is administered, either in the brachytherapy suite for HDR treatments, or in a radiation safe inpatient room for LDR treatments. During your hospital stay for patients required to stay overnight, you will be given Lomotil and will be on a low residue diet to rest the bowel. You will have an indwelling catheter in the bladder until discharge. You may have an epidural catheter or intravenous pain medication by pump for the management of any pain that you may have during your stay. This will be assessed and monitored by the anesthesiologist involved in your care. You will be on bed rest until the implant is removed. While on bed rest you will have elastic stockings and compression boots on both legs to prevent a blood clot from forming.

After the interstitial procedure, you may experience some spotting or bleeding from your vagina. You may experience some vaginal cramping after the procedure. This should stop by the end of the day. You may have some burning when you urinate for a day or two because a catheter was placed in your bladder during the procedure, which can cause some irritation. You should drink 8-10 cups of non-caffeinated beverages such as water, fruit juices, etc. for the next couple of days. The vagina may become irritated, and douching with a hydrogen peroxide douche may be recommended by your physician. The radiation sometimes causes the tissue in the vagina to tighten and narrow. You will be given a dilator to prevent narrowing or tightening of the vagina from radiation. Other side effects will be discussed with you by your physicians, some of which may be specific to your situation. You may notice that you are more tired, especially if the implants follow a course of external radiotherapy. Some patients feel exhausted and have little energy the first few weeks after the last implant. But the energy level gradually improves and you will be able to resume your usual activities.

Discharge instructions after gynecologic brachytherapy

You have recently completed a course of gynecologic brachytherapy that required an in-patient stay in the hospital.

Please contact the brachytherapy fellow should you have any of the following:

• A temperature >101.0 F
• Persistent or excessive bleeding (minor bleeding including blood in the urine or from the rectum is okay)

Please do:

• Resume regular diet as tolerated,
• Resume regular activities as tolerated,
• Resume prior meds, including any prior anticoagulation medicine,
• Use Sitz baths (warm water + baking soda or Demboros soaks) as needed,
• Use Tylenol or the Percocet prescribed for you at discharge as needed for pain,
• Take two tablets of Advil if you develop an increase in your urinary frequency after removal of the bladder catheter.

If you notice any skin sores, particularly on your back, please keep this area clear with soap and water, and place a foam pillow under the area when you sit or lie down. Please contact us for further instructions.

Please do not:

• Begin using the vaginal dilator or have sexual intercourse for at least two weeks until after your discharge

For any additional questions, please contact our brachytherapy coordinator, Jennifer Wilson, at (617) 732-6331.