Brachytherapy and Vaginal Shortening
Brachytherapy is a type of radiotherapy in which a sealed radiation source, such as seeds or wires containing radioactive material, is placed directly into or near a tumour. This allows for more precise targeting of the cancerous tissue and reduces the risk of damage to surrounding healthy tissue. Brachytherapy can be used to treat various types of cancer, including prostate, breast, cervical, and skin cancer. It can be administered as a permanent implant or as a temporary treatment with removable sources.
Vaginal Shortening
Vaginal shortening is a potential side effect of brachytherapy for gynaecological cancers. This occurs because the radiation can cause the tissues inside the vagina to become inflamed and scarred, leading to a reduction in vaginal length and elasticity.
Vaginal shortening after brachytherapy was identified to be more significant for women with cervical than for those with endometrial cancer. It was noted to be more common in those undergoing radiotherapy and surgery for cervical cancer than in those undergoing radiotherapy alone. In women who had undergone hysterectomy for endometrial cancer, the addition of external beam radiotherapy combined with brachytherapy resulted in greater toxicity than the addition of brachytherapy alone.
The severity of vaginal stenosis appears to be related to a higher dose per fraction of brachytherapy, an increased number of fractions and a smaller diameter of the brachytherapy applicator
Neither the patient’s age nor the disease stage contributed to the degree of vaginal stenosis. Women with stage II and III endometrial and cervical cancer experienced increased vaginal shortening compared with those with stage I disease.
Vaginal toxicity is more significant when the entire length of the vagina is irradiated rather than the vaginal apex. It was noted that the lower vagina has a poorer tolerance to radiation than the upper vagina. The effect on the vagina in women who smoke during radiotherapy is unknown. However, smoking is associated with an increased risk of radiation damage.
Prevention
To prevent or manage vaginal shortening, doctors may recommend using vaginal dilators or performing regular pelvic floor exercises. In severe cases, surgery may be necessary to restore the vaginal structure and function.
It’s essential to discuss any potential side effects of brachytherapy with your healthcare provider. Seek their recommendations for managing them and follow the advice.
Get in Touch
If you have concerns contact Dr Victoria Handley today on 0800 470 2009 or email vhandley@handleylaw.co.uk