Radiation therapy uses high-energy rays or particles to destroy cancer cells. Radiation may be used for vaginal cancer:
- as the primary treatment to destroy cancer cells
- before surgery, in combination with chemotherapy, to shrink a tumour (neoadjuvantneoadjuvantTreatment given to shrink a tumour before the first-line therapy (the first or standard treatment), which is usually surgery. radiation therapy)
- after surgery to destroy cancer cells left behind and to reduce the risk of the cancer recurring (adjuvantadjuvantTreatment given in addition to the first-line therapy (the first or standard treatment) to help reduce the risk of a disease (such as cancer) coming back (recurring). radiation therapy)
- to relieve pain or to control the symptoms of advanced vaginal cancer (palliative radiation therapy)
A combination of external beam radiation therapy and brachytherapy is usually used to treat vaginal cancer.
The amount of radiation given during treatment, and when and how it is given, will be different for each person.
External beam radiation therapy
Vaginal cancer is generally treated with external beam radiation therapy. A machine directs radiation to the tumour and some of the surrounding tissue. External beam radiation is used to treat most stages of vaginal cancer. It may be given alone to treat lymph nodes in the groin and pelvis.
Brachytherapy is internal radiation therapy. A radioactive material (radioactive isotope) is placed right into, or very close to, the tumour. Radioactive materials can also be placed in the area from where the tumour was removed. The radiation kills the cancer cells over time.
- Radiation therapy for stage I superficial tumours is usually brachytherapy alone.
- Larger stage I tumours and other stages are treated with a combination of external beam radiation therapy and brachytherapy – intracavitary brachytherapy, interstitial brachytherapy or both.
The radioactive material is placed in a special applicator (cylinder) and inserted into the vagina near the location of the tumour.
Thin radioactive tubes are inserted directly into the tumour and surrounding tissue. The implants can be temporary or permanent:
- Temporary implants are removed after the desired dose of radiation is delivered.
- Permanent implants (such as radioactive seeds) are not removed. They slowly deliver their dose of radiation over a period of weeks or months.
Either low-dose-rate (LDR) brachytherapy or high-dose-rate (HDR) brachytherapy will be given.
Low-dose-rate (LDR) treatment
LDR brachytherapy delivers continuous, low doses of radiation over hours or days. The implant often stays in for 1 to 7 days and is then removed. A hospital stay is usually required, and special radiation safety precautions are in place to protect others from being exposed to radiation. Once the implant is removed, the person is not radioactive and can safely be around people.
- For LDR brachytherapy, the radioactive material is put inside a special hollow applicator that is inserted into the vagina.
- Once the applicator is loaded with the radioactive material, the woman stays in bed to keep it from moving during treatment. The labia may be sutured closed to keep the applicator in place.
- During this time, some radiation is detectable outside the body, so radiation safety precautions are necessary to protect other patients, staff and visitors from radiation exposure.
- When the prescribed dose of radiation has been given, the applicator is removed and the woman is able to go home.
- Repeated treatments may be recommended.
High-dose-rate (HDR) treatment
HDR brachytherapy, also called remote brachytherapy, delivers a single high dose of radiation in a very short period of time. A single treatment usually takes a few minutes. The radioactive material travels from a special machine attached to catheters or needles inserted into the tumour.
- The catheters may stay in place between treatments or be put in place before each treatment.
- There may be a hospital stay, but HDR brachytherapy is most often done on an outpatient basis.
- Once the treatment is given, the radioactive material goes back into the machine and the person is not radioactive.
- HDR brachytherapy may be given weekly, every 1–2 weeks for at least 3 doses.
See a list of questions to ask your doctor about radiation therapy.