Brachytherapy is an internal radiation therapy that people may have during treatment for endometrial cancer. A doctor may suggest brachytherapy after surgery or if surgery is not an option.

The duration of and recovery from brachytherapy can depend on the type of brachytherapy a person has.

This article explains what brachytherapy involves, its effectiveness, and potential risks and side effects. It also discusses recovery and other treatment options.

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Brachytherapy delivers radioactive material into the body to destroy cancer cells. According to the American Cancer Society (ACS), people will usually have brachytherapy after surgery to remove the uterus and cervix.

Vaginal brachytherapy treats the upper section of the vagina, which is closest to the uterus. Doctors insert a cylindrical applicator containing radioactive material into the vagina to deliver radiation.

The applicator mostly delivers radiation to the areas it is in contact with. Other areas, such as the bladder, receive less exposure.

Doctors may use low dose rate (LDR) or high dose rate (HDR) brachytherapy to treat endometrial cancer.

LDR brachytherapy delivers lower radiation over an extended period, usually around 1 to 4 days. People must lie still during treatment to avoid moving the applicator.

HDR brachytherapy delivers a stronger dose of radiation over a shorter time frame, usually around 10 to 20 minutes. People may have treatments daily or weekly, with at least three treatments.

A person may have brachytherapy and other treatments. Doctors can use brachytherapy in the following ways:

  • following a hysterectomy to destroy any remaining cancer cells
  • before surgery to shrink a tumor
  • after external beam radiation, which delivers radiation from outside the body
  • as the primary treatment if surgery is not an option

Doctors may suggest brachytherapy to treat higher-grade tumors following surgery or if endometrial cancer has spread to surrounding areas.

According to 2023 guidelines from the American Society for Radiation Oncology, vaginal brachytherapy significantly reduces the risk of endometrial cancer recurring in the vagina.

A 2020 study suggests external beam radiation with brachytherapy is an effective treatment option for inoperable endometrial cancer.

According to a 2020 systematic review of people with stage 2 endometrial cancer, external beam radiation significantly reduced pelvic and vaginal recurrence, with or without brachytherapy, compared to brachytherapy alone.

However, the treatments did not have a difference in overall survival.

The study noted that vaginal brachytherapy might be an effective treatment for people with node-negative stage 2 endometrial cancer and no uterine risk factors.

According to the ACS, LDR brachytherapy carries a risk of deep vein thrombosis. This is due to prolonged immobility during treatment.

However, it is worth noting that LDR brachytherapy is not a common treatment option in the United States.

Another potential risk is radiation vaginitis. This is an irritation of the vagina that can cause discharge, discomfort, and open sores in the vagina.

Brachytherapy may also reduce blood counts. It can cause anemia due to low red blood cells, and people may experience fatigue.

It can also cause leukopenia, a low white blood cell count. This condition may increase a person’s risk of infection.

Low blood counts are a temporary side effect of radiation therapy. These counts usually return to typical levels within a few weeks of stopping treatment.

Is brachytherapy painful?

People may feel some discomfort with the applicator. However, they can speak with their doctor if this occurs. Pain medications can help to ease any pain during treatment.

A person may also experience some discomfort due to potential side effects of brachytherapy, such as vaginal irritation or discomfort. A doctor can recommend treatments for any uncomfortable side effects.

Potential long-term side effects of brachytherapy include:

  • vaginal dryness due to changes in the vaginal lining
  • vaginal scar tissue, which can cause the vagina to become narrower and shorter and may make sex painful
  • radiation cystitis, an inflammation of the bladder that may cause urinary problems

If people experience any of the above, they should speak with a doctor. The doctor can suggest treatment options, such as pelvic floor therapy, vaginal dilators, or physical therapy.

People need to stay in hospital for LDR brachytherapy but may be able to go home the same day for HDR brachytherapy.

Recovery from brachytherapy can vary from person to person. However, according to the Canadian Cancer Society, most side effects usually resolve within a few weeks or 2 months after treatment.

People may experience fatigue for several weeks or months after treatment.

Some side effects may last longer, as it can take time for healthy cells to repair after radiation therapy. Some side effects may occur months or years after brachytherapy, and some can be long-lasting.

Surgery is usually the first-line treatment for endometrial cancer. If surgery is not an option, people may have radiation therapy. This can include brachytherapy, external beam radiation, or both.

For more advanced cancers, people may have brachytherapy after surgery.

Other treatment options can include:

  • progestin therapy for stage IA grade 1 endometrioid cancers
  • chemotherapy before or after surgery, with or without radiation therapy
  • immunotherapy or targeted drugs if surgery and radiation are not suitable
  • hormone therapy for cancer that has spread

Choosing the right treatment

Before deciding on treatment, people can discuss the options and their potential risks and benefits with a doctor. Factors affecting treatment can include:

  • the stage and location of cancer
  • tumor size
  • age
  • overall health
  • if people want to become pregnant
  • which treatments may be effective on the cancer cells

Doctors may also suggest clinical trials testing new treatments if a person has advanced cancer.

Brachytherapy uses an applicator to deliver radiation inside the vagina to treat endometrial cancer.

People may have brachytherapy after surgery or if surgery is not an option. Doctors may use it alongside external beam radiation or other cancer treatments.

Side effects may include vaginal irritation and dryness, fatigue, and low blood counts. However, side effects typically clear up within a few months of finishing treatment.