Oesophageal Brachytherapy

It will be given to you in addition to the information you will receive from your Clinical Oncologist (who is a specialist doctor in cancer treatment).

The leaflet describes brachytherapy planning and treatment. It also explains the side-effects which you may experience during and after treatment.

Each person’s treatment will vary, so the information given is a general guide. The healthcare team looking after you will explain your treatment and the side-effects in detail. If you have any questions after reading this leaflet, please speak to the team looking after you or ring the numbers at the end of leaflet. Staff will make every effort to meet your individual needs or will direct you to the person who can help.

All your brachytherapy planning and treatment will take place in the Brachytherapy /Rutherford Suite on Level -1, Bexley Wing, Leeds Cancer Centre (LS9 7TF).

What is brachytherapy?

Brachytherapy is a form of radiotherapy where a radioactive source or sources are placed close to or within the tumour. This results in the treatment area receiving a high dose of radiation whilst the dose to surrounding tissue is lower. The treatment is given as an outpatient.

Oesophageal Brachytherapy treatment

This is an internal treatment usually given 4-6 weeks following completion of external beam radiation or if there is evidence of recurrence of the cancer sometime after external beam radiation. It can be given in a single treatment or in two treatments one week apart. Your doctor will discuss this with you.

Fasting Instructions

Solids and milk containing drinks should not be consumed from midnight on day of procedure.

All patients can drink clear, still, unflavoured water up to two hours prior to procedure 07:30am – 250mls water. If you are diabetic please discuss this with your doctor.

What does the treatment involve?

You will be asked to come in at 08.00 on the morning of your treatment. You will have your planning and treatment the same day and will be free to go home at approximately 2pm (14.00)

Planning

A brachytherapy radiographer will accompany you to the radiology department where you will have a nasogastric tube passed into your nose to your stomach.

This procedure is performed under X-Ray guidance to ensure the tube is in the correct position.

Once this tube is in place, a second tube (treatment applicator) in inserted into the naso gastric tube.

The applicator is secured in placed with tape.

The brachytherapy radiographer will then take you for a CT scan.

The CT scan is used to assess the position of the applicator and enable us to target the tumour accurately.

Following the CT scan you will be accompanied back to the brachytherapy department where you can wait for your treatment. This stage is known as planning and will take a few hours.

During this time you can have fluids and light snacks.

The nasogastric tube will remain in place until your treatment has been delivered.

Treatment

The treatment machine contains a small radioactive pellet which when switched on will travel down the treatment tube.

As the pellet travels along the tube it delivers a measured amount of radiation treatment to the tumour, which enables us to deliver a high dose of radiation to supplement the external radiation which you have already received.

The high dose of radiation is given at close range directly into the tumour. The dose of radiation quickly decreases as it moves away from the tumour area and this reduces the dose of radiation to the normal surrounding tissue such as the heart, lungs and spinal cord.

Treatment delivery

Once your customised plan has been checked it will be loaded into the treatment machine.

You will be taken to the treatment room, where you will be asked to lie on the treatment couch. Once you are comfortably seated the treatment applicator will be connected to the machine. The treatment usually takes approximately 15-30 minutes. You will not feel anything during treatment.

Whilst the treatment is given, you will be in the room alone but the brachytherapy radiographers will watch you using closed circuit TV (CCTV) monitor during treatment. The CCTV camera is not recording or saving any images. There is also an intercom system so the radiographers can talk to you.

There is a radio in the treatment room if you wish to listen during treatment.

On completion of the treatment the source returns into the treatment machine.

The nasogastric and treatment applicators will be removed by a radiographer.

Side-effects

Side-effects can be divided into short term (acute) effects, that happen during or soon after treatment, and long term effects occurring months or years later. Some side-effects
are common, whilst others are rare. The area and amount of treatment given to you will affect which side-effects are most likely to happen to you. Your oncologist will discuss this with you. If you develop any radiotherapy side-effects you will be given advice and support by your healthcare team.

The procedure is well tolerated but most patients will experience some side effects. The main side effects are mild nausea, heartburns, pain and difficulty swallowing which will occur within one week of treatment and may last a few weeks.

You will be prescribed medications (ant sickness and Mucaine) to control these symptoms and will be offered a weekly telephone follow up review.

The procedure may be abandoned if difficulties are encountered.

The serious but rare side effects of this treatment include perforation (rupture) of the oesophagus or bleeding from the gullet due to severe ulceration. This is very rare but you must seek emergency medical help (ring for an ambulance) and contact the team if you encounter any symptoms of severe chest pain and or bleeding from the gullet (vomiting of blood or very black motions).

Sometimes after this treatment the gullet develops a narrowing (stricture) due to scaring from the treatment. This may occur months to years after treatment and can be treated by endoscopy (camera test) and dilation (stretching of the gullet).

There is also a low risk of developing and abnormal tract
(fistula) a few months after radiotherapy. This is another rare late side effect

When will I see the doctor again

You will usually have a telephone follow up or a face to face consultation if required, 1-2 months following completion of treatment.

Student radiographers

The radiotherapy department is a training centre for therapeutic radiographers of any gender. They are supervised at all times.
If you do not wish students to be present, please speak to a member of staff. This will not affect your treatment or care.

Hotel Bexley Wing

The hotel is located on the 8th floor of Bexley wing and offers single and double rooms each with an en-suite, tea and coffee making facilities and digital television. Single rooms with wheel chair access are also available. 23 Patients are able to stay free of charge. There is a charge for relatives if they are staying in their own room. For further details please contact the Hotel Co-ordinator on 0113 206 7687. Out of hours please contact the Non-surgical Oncology Nurse Practitioner through main switch board on 0113 243 3144.

Car Parking

Parking for radiotherapy planning and treatment is free.

On entering the car park take a ticket and park as usual
(disabled parking spaces are on Level 0). When exiting use the left hand lane next to the ticket office.

Take your parking ticket and appointment letter to the attendant.

They will process your ticket so that when you insert it at the barrier no charge will be made.

If you need assistance or are unable to leave your car please press the button on the barrier.

Research at Leeds Cancer Centre

Leeds Cancer Centre is a major centre for cancer research. You may be asked if you would like to help with some of the clinical studies. You are under no obligation to take part in any trials, and your treatment will not be affected in any way if you do not wish to take part.

If you do take part in a clinical trial, you may meet a research nurse or radiographer who will be helping to run the trial.

Further information and support

If you have any questions please ask your hospital team. We all have our own ways of coping with difficulties.

Some people have a close network of family and friends who provide emotional support. Others would rather seek help from people who are not involved with their illness.

The following are also available as sources of information and support that you may wish to use.

Local Support Services

National Support Organisations