Cervical cancer and brachytherapy

Introduction:

Cervical cancer, any malignant growth that begins in the cells of cervix. Cervical cancer is the 4th most frequent cancer in females globally, and it is the second largest cause of cancer mortality in the developing countries. It is most commonly detected in women aged 35 to 44. 

The standard of treatment for women with locally advanced cervical cancer has progressed from external beam radiation therapy (EBRT) alone to EBRT with brachytherapy, and finally to a combination of EBRT plus brachytherapy with concomitant chemotherapy.

Brachytherapy, uses radiation source in close proximity to a tumor. This technique makes use of the inverse square law, which states that the dose of radiation decreases fast as the distance from the source rises. As a result, brachytherapy can deliver a high dosage of radiation to a close tumor while avoiding injury to neighboring tissues or organs. Brachytherapy is the only proven means of delivering the high dosage necessary to treat cervical cancer while minimizing adverse effects.

Types of Brachytherapy 

Brachytherapy is classified into three categories:

1. The patient will have the implant with the radiation source in situ for 1 to 7 days during Low-dose rate (LDR) brachytherapy. The implant will give continuous radiation with LDR. The patient will be admitted to the hospital and cared for by medical personnel. After this period, the implant will be removed. 
2. High-dose rate (HDR) brachytherapy is frequently performed as an outpatient procedure. The radiation source is only used for 10 to 20 minutes at a time in the implant. The implant's ability to remain in place between treatments is determined by the treatment regimen. 
3. Pulse-dose rate (PDR) brachytherapy is a cross between HDR and LDR brachytherapy. The treatment employs a similar dose of radiation as HDR but for a shorter time. For the length of the therapy, the implant provides a series of brief exposures, or "pulses," at a rate of 10 to 30 minutes per hour (rather than continuously). The implant, like LDR, will remain in place for the life of the treatment regimen.

Side Effects

• The short-term negative effects of cervical cancer brachytherapy are generally limited to the pelvic region. 

1. They might include vaginal or vulvar irritation, vaginal discharge, or stomach pain. 
2. In some situations, one may also experience exhaustion, nausea, vomiting, and diarrhea. 

• Long-term adverse effects or consequences from radiation therapies such as brachytherapy include 

1. vaginal stenosis, 
2. vaginal dryness, 
3. radiation cystitis, and others.