Brachytherapy is the treatment of malignant tumors by radioactive sources that are implanted, typically under general anesthesia, close to (intercavitary) or within (interstitial) the tumor. It may be used as adjuvant therapy following surgery or as primary therapy if the malignancy is advanced. Currently, radiation therapy is geared mainly toward cervical and uterine cancers and remains limited in ovarian cancer.
The normal tissues of the cervix and uterus can tolerate very high doses of radiation. In contrast, the sigmoid, rectosigmoid, and rectum do not and, therefore, are more susceptible to radiation injury. Usually the small bowel is spared because it is in motion. Acute radiation cystitis can occur in the immediate postoperative period. Symptoms of cystitis are present but cultures are negative. Treatment is to increase oral intake and take a urinary analgesic. Chronic radiation cystititis with hematuria requires continuous bladder irrigation.
Radiation induced soft tissue necrosis can also be a significant complication. It is thought to be due to a progressive end arteritis leading to decreased blood flow and eventually hypoxia. Often this leads to inflammation, infection, tissue breakdown, and fistula formation. The use of hyperbaric oxygen has been shown to enhance healing.
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