A photograph of Dr. Krisha J. Howell sitting in front of a computer, smiling as she speaks with a patient.

Treating Gynecologic Cancers with Brachytherapy

  • Radiation therapy has long been used to treat gynecologic cancers. But not every patient with gynecologic cancer is aware of brachytherapy, a targeted form of radiation therapy that has become more advanced in recent years, offering another effective option for patients.

    Brachytherapy is a form of internal radiation that can provide higher doses of radiation to a more targeted area compared to external beam radiation therapy (EBRT), where high-energy X-ray beams are aimed at a tumor from outside the body.

    “With brachytherapy, we place radioactive sources directly into the site we want to treat,” explained radiation oncologist Krisha J. Howell, MD, Clinical Director of Radiation Oncology at Fox Chase Cancer Center. As a result, the radiation is targeted away from nearby organs like the bladder or rectum. That can lower the risk for side effects and complications.

    Several types of gynecologic cancer can now be treated with brachytherapy, including cervical, vaginal, and uterine (also known as endometrial) cancers. Depending on the type and stage of a patient’s cancer, brachytherapy can be used alone or as part of a larger treatment plan that includes EBRT, surgery, and/or chemotherapy.

    Specialized Delivery for Gynecologic Cancers

    Brachytherapy for gynecologic cancer can be administered in different ways depending on a patient’s diagnosis.

    For patients who no longer have a uterus and cervix, uterine cancers near the top of the vagina can receive radiation via a targeted vaginal cylinder. “It’s similar to a vaginal ultrasound probe,” Dr. Howell said. This is a short, relatively pain-free procedure and doesn’t require a hospital stay. Once the cylinder is removed, “patients are no longer radioactive, and there are no constraints on who they can engage with,” Dr. Howell explained.

    For patients who still have a uterus, brachytherapy for cervical cancer usually involves inserting a high-dose radiation device, called a tandem, directly into the cervical OS, and an ovoid applicator nearby. The device is left in the cervix for several minutes while it delivers radiation and is then removed. “There can be some discomfort,” Dr. Howell said. “To minimize that, we do cervical brachytherapy under general anesthesia.”

    Compared to EBRT, basic brachytherapy for gynecologic cancers has a lower chance for side effects, Howell noted. But it’s not entirely without risk. Women can experience cramping, spotting, or soreness after the procedure, and other, less common side effects to regional organs may occur. Patients should weigh their individual benefits and risks with their care team.

    Experience and Expertise Matter

    As with other advanced treatments, brachytherapy is best performed by a multidisciplinary care team at a major cancer center.

    “At Fox Chase, we have one of the largest brachytherapy programs in the Eastern United States,” Dr. Howell said. “We have decades of experience, specialized staff, and the state-of-the-art equipment for delivering brachytherapy. Going to a center of excellence will maximize your outcome and minimize your inconvenience.”

    It’s also worth it to seek out a second opinion on brachytherapy even if your oncologist has recommended EBRT.

    “Some patients can go either way, and choosing one over the other could have a huge impact on their life,” Howell explained. “Brachytherapy takes less time and patients feel better, so they don’t necessarily have to rearrange their life or take a leave of absence from work to get treatment.”

    Learn more about brachytherapy treatment at Fox Chase.