Updated: 10 August 2005
This section is intended as a guide to the average length of time required for standard radiotherapy used for common gynecological malignancies. It may be helpful for counseling your patient, but final treatment recommendations will need to be made on an individual basis.
1. External Beam Radiotherapy
Treatment to the pelvis usually requires five weeks of daily visits. Treatments only take a few minutes per day, and are given Monday through Friday. Prior to starting treatment, patients require an additional appointment for simulation and planning, where appropriate fields are outlined and radiation doses are calculated.
Treatment for ovarian cancer is usually given to both the upper abdomen and the pelvis. This is a longer program, lasting for 6.5 weeks of daily visits.
a) Vaginal Vault Treatment after Hysterectomy
This can either be given as an additional "boost" treatment following external beam therapy, or alone as the only form of radiation therapy.
Treatment can be given on an outpatient basis using a "high dose rate" radioactive iridium source. The procedure involves inserting a plastic applicator (referred to as the vaginal obturator or cylinder) into the vagina. These come in different sizes. The iridium source is placed inside the applicator. The treatment only takes a few minutes, and the patient is able to go home right away afterwards.
Treatment can be given on an inpatient basis using "low dose rate" cesium pellets. A plastic applicator is inserted into the vagina, and attached to a belt to hold it into position. Patients require a urinary catheter and enema before this procedure, as it may last from 3 to 18 hours during which time they must remain recumbent in bed. For the 18 hour treatment time, this may result in an overnight hospital stay.
b) Intrauterine Treatment for Cervix/Endometrial Cancers
Usually patients will also be receiving 5 weeks of external beam therapy, as well as these additional treatments to give a high dose of radiation to the areas of gross disease.
Treatment can be given on an outpatient basis using the "high dose rate" radioactive source. This requires 3-5 separate treatments. Each treatment requires dilation of the cervix, with placement of a tube through the cervix into the uterine cavity. This requires sterile technique, and either sedation or anaesthetic. The patient will not need to stay overnight in hospital. This outpatient procedure is not yet available at all centres.
Inpatient Treatment (Selectron)
Patients are admitted to hospital, and intrauterine and intravaginal tubes are placed under a general or spinal anaesthetic. The procedure takes about 90 minutes to perform. After recovery from the anaesthetic, patients are returned to the hospital ward where radioactive cesium pellets are loaded into the tubes. The patients usually require about 24 hours of bed rest with the tubes in place, so they need a urinary catheter and enema. They are usually able to go home a few hours after the tubes are removed. This procedure is usually done twice, separated by one week.
c) Primary Vaginal Cancer Treatment
Inpatient Treatment (Interstitial Implant)
On rare occasions, patients may require a temporary interstitial implant for tumours originating in the vagina. This procedure is done under general or spinal anaesthetic, and may require admission to hospital for up to 5 days of bed rest for treatments. Plastic tubing or stainless steel needles are placed directly into the tissue to allow sources to be placed directly into the tissues. At the end of the treatments, the sources and tubing are removed. This is generally more uncomfortable for the patients, requiring considerable supportive care in hospital and analgesics.