Radiotherapy with caesium
This page tells you about caesium or iridium internal radiotherapy treatment. There is information about
Caesium and iridium are both radioactive metals called radioactive sources. Doctors can use them to treat cancer of the cervix, womb (also called uterine or endometrial cancer) and vagina. The types used in these treatments are called Caesium 137 and Iridium 192. The treatments are also called caesium or iridium insertion.
To give caesium or iridium treatment, doctors put applicators inside your cervix (neck of the womb) and vagina while you are under a general anaesthetic. The applicators are like long, plastic tampons. This procedure is usually done in the operating room. When the applicators are put in, you may also have a tube (urinary catheter) put into your bladder at the same time. The diagram below shows the applicators in place for womb cancer treatment.
You may have an X-ray once the applicators are in place, to check that they are in the right position.
Once you are back on the ward, or in a specially shielded room, the nurses attach tubes from a machine to the applicators. When the machine is switched on it sends small radioactive metal balls into the applicators to treat the cancer. The applicators can be uncomfortable. Your nurse will give you regular painkillers if you need them. Let your nurse know if you are still uncomfortable so that they can change the dose of the painkiller.
Once the machine is switched on, you have to stay in bed. This helps to keep the applicators in the correct position. If you need anything you can call the nurse by using the call bell by your bed.
You will most likely have treatment by a machine called either a Curietron, Selectron, or Microselectron. The machine puts the radioactive metal balls into the applicators automatically.
When someone needs to go into your room the machine can be turned off. The machine pulls the radioactive sources back through the tubes and inside the machine. So your visitors and the hospital staff won't be exposed to as much radiation. But they will still need to follow hospital safety procedures and visiting restrictions. Some hospitals use pulsed dose brachytherapy machines (PDR machines). Every hour or so your nurse connects you to a machine that gives the radiotherapy. At other times you are free to have visitors.
Internal radiotherapy may take less than an hour or up to 2 days, depending on the type of machine that is used. Some machines give a low dose over a long time and some give a high dose over a shorter time.
If you have low dose rate treatment, it usually takes between 12 and 48 hours, depending on how much external radiotherapy you have had. Your doctors will plan your total radiotherapy dose and your nurses will monitor the machine to give that dose. If the machine needs to be switched off a lot, the time to give the radiotherapy will be longer.
The doctor or nurse takes the applicators out once you've had your dose of radiation. This is usually done on the ward in your side room. It can be a bit uncomfortable. You will be asked if you want to take some painkillers beforehand. Sometimes a few breaths of the gas Entonox can help you to relax.
The nurses check that all the applicators have been removed. And they take the tube draining your urine (catheter) out at the same time.
High dose rate treatment machines have sources that give off radiation more quickly. So the treatment time is shorter. The treatment may only last between 5 and 15 minutes. But you may need up to 6 treatments, up to a week apart, with this type of machine. You have the applicators put in under general anaesthetic.
In some hospitals, a small plastic cuff is left in place, in the opening of your cervix. This is a narrow plastic tube, to guide the applicators after the first treatment. If your hospital gives the treatment this way, you may not need an anaesthetic the second time around. Once the treatment is over, the plastic cuff is taken out. This is quick but can be a bit painful. You may want to ask for pain relief while it is done, such as gas and air (Entonox) or painkilling tablets.
Once the radioactive sources are removed, all the radioactivity disappears. You can usually go home the same, or next day.
Some doctors may suggest that you use vaginal douches to clean the vagina for a few days afterwards, but this is not common. If you have questions or concerns about douching, talk them over with your doctor or specialist nurse.
Your doctor or specialist nurse will advise you to drink plenty of fluids. This helps to flush out your bladder and stop you from getting inflammation or infection of the bladder.
The side effects of caesium or iridium internal radiotherapy are the same as those explained in the section about the side effects of stomach and abdominal radiotherapy.
There is a small risk of infection after caesium or irridium insertion but it is rare. If you get a high temperature or heavy bleeding after your treatment, contact your doctor as soon as possible. Your doctor will probably give you antibiotics to clear up any infection.
Radiotherapy to the vaginal area can make your vagina narrower after some time. The tissue can become stiffer and less stretchy. Doctors call this fibrosis. Your doctor or nurse will recommend that you use vaginal dilators to help stretch your vagina and prevent it from getting narrow. There is detailed information about vaginal dilators in the page about sex and cancer for women in the coping with cancer section.
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