High Dose Rate (HDR) Brachytherapy for Head and Neck Cancer
What is HDR brachytherapy?
HDR brachytherapy is a type of radiation that is used to treat cancer. HDR brachytherapy delivers a highly concentrated dose of radiation in and around the tumor while sparing much of the surrounding healthy tissue.
Brachytherapy may be used alone or in combination with external beam radiation and/or surgery. It may cure, control, or relieve symptoms of many different types of cancer.
In brachytherapy, radiation therapy is delivered for a set length of time by a radioactive source that comes in the form of a small seed. The dose of radiation and length of time prescribed will depend on the tumor size and location.
Catheters (soft tubes) for brachytherapy will be placed in the tumor during a procedure done in the operating room.
Preparation and surgery
Routine lab work, x-rays, and an echocardiogram (EKG) may be ordered by your doctor before the day of surgery. On the morning you are admitted to the hospital, you will be asked to sign a consent to undergo or receive brachytherapy if this was not done previously. If surgery is planned, your surgeon will have you sign a separate consent. If the catheters will be placed in or around your neck, you may need to have a tracheotomy (tray-key-OTTuh- me). A tracheotomy is an opening that is made in the trachea (windpipe) through the throat to enable you to breathe.
Your surgeon will talk with you about this. Your surgeon and radiation oncologist will be present during your surgery. Your radiation oncologist will determine the number of catheters that need to be placed to treat the area.
In the operating room, you will be given either local or general anesthesia. Your radiation oncologist will place hollow catheters in your body, inside and near the site of the tumor. Once the catheters are in place, nonradioactive wires will be placed in the catheters. These wires keep the catheters open and allow them to be seen on x-ray after surgery. The catheters do not hold any radioactive source at the time of surgery.
You will recover from anesthesia in the recovery room. From the recovery room, you will be taken to the Radiation Oncology Department where the radiation oncologist will use special measurements and x-rays to plan your treatment. The planning may take several hours to complete depending on the number of catheters being used. Medication will be available if you experience discomfort during this planning session.
After the radiation dose is determined, you will be taken to the HDR treatment room where the catheters will be attached to special carriers in the HDR machine. You will either be on a stretcher or seated comfortably in a chair. Attaching the catheters takes a short time. Sometimes movement of the catheters may cause some discomfort. Medication will be available if you experience discomfort.
All staff will leave the room during the actual treatment with the radioactive source. You will be closely monitored through use of a video camera and an intercom. The sources will be loaded and removed from the catheters by a special machine called an HDR remote afterloader. Once the treatment is complete, the special carriers will be detached from your catheters. You will be returned to either the Same Day Surgery Center or to your room in the hospital.
You will receive the actual radiation treatments twice daily, once in the morning and once in the afternoon, for a period of two to six days. Most patients stay in the hospital during this time. Your radiation oncologist will tell you how many treatments you will receive.
Activity with the catheters in place
Your doctor may restrict your activity while you are in the hospital. You may be put on bed rest to avoid moving or bending the catheters. You will not be able to shower until the catheters are removed after the last treatment. No moisture should get into the catheters. If the catheters become bent or are moist inside, it will be difficult for the radioactive source to pass through them.
Clothing may be worn over the catheter insertion site as long as it is loose and will not rub or bend the catheters. If at any time you notice a catheter is bent or is coming out, tell your radiation oncology doctor immediately.
The only time that you are kept away from others because of the radiation is during the actual treatment. If you go home between visits, you may perform your usual activities and visit with friends and family as you like. Most patients do not work during their HDR treatment.
If you are hospitalized during the course of the treatment, you may read, do small hobbies, watch television, use the telephone, and walk in the hallway (if you are not on bed rest). If you are receiving treatment in the head or neck area, you may need to have a feeding tube inserted during the treatment. The tube is inserted through your nostril and leads to your stomach. Only liquids are given through the tube.
If you are on bed rest, turning, gentle coughing, deep breathing, and “foot waving” exercises should be done every hour while you are awake to prevent complications. You may have special stockings placed on your legs to help your blood circulate while you are lying down.
Diet and medications
A well-balanced diet is important to help you tolerate the stress of disease, surgery, and the brachytherapy treatments. Changes in your diet may be required. Any dietary changes will be discussed with you before the procedure.
Medications that you took before being admitted to the hospital will be continued unless your primary care doctor decides otherwise. Medications for pain, relaxation, and sleep will be available as needed or prescribed for you if you are discharged. Please feel free to discuss your needs with your nurse.
Safety precautions
You and the hospital staff must follow certain safety precautions during the HDR treatment. These precautions are necessary so that staff will be exposed to as little radiation as possible.
Do not move while the radiation treatment is being given. Do not touch the catheters or the HDR machine. Once the procedure is complete, the staff will check for any radiation in the room to confirm that the source has returned to the HDR machine. You may notice staff wearing small badges on their clothing. These badges measure their radiation exposure so that they do not get too much in caring for all of their patients.
Removal of the catheters
The removal of the radiation catheters by your radiation oncologist takes only a few minutes and may be done in the operating room or the Radiation Oncology Department. Pain medication will be available to you before or after the procedure if you need it. Once the catheters are removed, a light dressing may be applied over the insertion sites.
After you are discharged
Activity - You may experience some fatigue for a few weeks following brachytherapy and/or surgery. You may find it helpful to plan rest periods throughout your day. If you had surgery, your surgeon will discuss what activities you can and cannot do.
Diet - You may eat your normal diet after discharge unless your doctor gives other instructions.
Mouth Care - Rinse your mouth with a mixture of ½ teaspoon of sodium bicarbonate (baking soda) and 8 ounces of water. This should be done at least after every meal and at bedtime. Avoid mouthwash that contains alcohol, which can cause dryness in your mouth.
Other instructions:______________________________________________________________
Skin care - If you had surgery and have a dressing, your surgeon will tell you when you can remove it and how to care for the incision. Skin reddening in the area that was treated is a normal reaction after brachytherapy. There may also be some hair loss in that area.
The skin may also become irritated from the catheters. The following guidelines will help promote comfort and healing in the affected area:
- Wash the area with mild soap and lukewarm water and gently pat it dry.
- Avoid extreme temperatures on the affected area, such as hot showers, hot water bottles, heating pads, or ice bags.
- Avoid any friction or rubbing of clothing on the skin. Do not scratch the area. If itching occurs, call the radiation oncology doctor and/or nurse for medication.
- Wear cotton clothing to allow air flow to the affected skin.
- Avoid the use of commercial lotions or powders unless recommended by the radiation oncology nurse.
What to ask your nurse or doctor
Ask your nurse or doctor any questions you may have about the following:
- products to moisturize the skin
- concerns about treatments or procedures
- suggestions about ways to keep your mouth moist
- availability of support groups
Things to report to your nurse or doctor
Tell your nurse or doctor if you have any of the following symptoms:
- inability to eat your usual diet
- sores in your mouth or on your lips
- red, swollen, or tender areas of skin
- peeling of the skin that leaves the treatment area sore and moist
Things to report immediately
Call immediately if you have any of the following symptoms:
- unusual bleeding
- difficulty catching your breath
- temperature of 100.5 F (38.0 C) or higher
- chills
- severe discomfort in the treatment area not relieved by your prescription pain medicine
In an emergency, call:
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Revised December 2010