HDR Gynecologic Brachytherapy for Gynecologic Cancer

HDR (High-Dose Rate) gynecologic brachytherapy is a type of internal radiation therapy that delivers a high dose of radiation in a short period of time. Because the radiation is aimed directly at the tumor, it limits damage to nearby tissues.

This type of radiation therapy treats gynecologic cancer, including cancers of the cervix, endometrium, and vagina.

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What Is HDR Gynecologic Brachytherapy?

Radiation therapy kills cancer and shrinks tumors using high-energy waves to damage the DNA of the cancer cells. HDR gynecologic brachytherapy is a type of internal radiation therapy.

To perform brachytherapy, doctors insert plastic tubes, thin metal rods, or needles into the body. These then deliver radiation directly to the tumor.

This type of radiation therapy limits the damage to nearby tissues. In gynecological cancer, that means doctors can avoid damaging the bladder and bowel.

Brachytherapy delivers high doses of radiation. That means it usually takes fewer sessions than traditional external beam radiation. It may also cause fewer side effects.

Types of HDR gynecologic brachytherapy

Interstitial brachytherapy

This kind of brachytherapy uses applicators made of thin, flexible tubes or needles to place radiation directly into the tumor and surrounding tissues. It typically requires general anesthesia so that doctors can surgically place the applicators.

The patient will stay in the hospital and receive one or two short radiation sessions per day for three or four days. When the brachytherapy is complete, doctors will remove the applicators.

Intracavitary brachytherapy

This kind of brachytherapy uses an applicator that resembles a large, hollow tampon. The provider places the applicator in the vagina right before radiation treatment and removes it right after.

Intracavitary brachytherapy does not require a hospital stay.

Conditions we treat with HDR gynecologic brachytherapy

HDR brachytherapy is often used to treat the following gynecological cancers:

Why Would I Need HDR Gynecologic Brachytherapy?

Your provider may recommend HDR brachytherapy if you have a gynecological cancer that is best treated with radiation. It can deliver radiation directly to the tumor. This can shorten the number of treatment sessions you need and limit the damage to nearby tissues.

Brachytherapy can also be combined with surgery and external beam radiation.

Who’s a candidate for HDR gynecologic brachytherapy?

HDR brachytherapy isn’t right for all gynecological cancer patients. It treats cancers that are confined to a specific part of the body. If your cancer has metastasized, or spread, brachytherapy would not be right for you.

Brachytherapy can be a good option for patients with localized cancer, or cancer that hasn’t spread. It can reach tumors that may be difficult to remove with surgery. It can also be combined with surgery and external beam radiation therapy.

Brachytherapy delivers a high dose of radiation directly to the tumor. You may need fewer treatment sessions than other types of radiation, and you may have fewer side effects.

Alternatives to HDR gynecologic brachytherapy

If you are not a candidate for HDR gynecologic brachytherapy, your doctor may recommend another treatment for your cancer.

Those treatments may include:

Chemotherapy — Chemotherapy uses powerful drugs to kill cancer cells. Providers can use several different methods of giving chemotherapy depending on your type and stage of cancer.
External beam radiation — This type of radiation is noninvasive. It uses a machine to direct high-energy waves at the tumor from outside the body. It can be combined with brachytherapy in some cases.
Hormone therapy — In some cancers, your body’s natural hormones may cause your cancer to grow. In hormone therapy, doctors can either block or stop your body from producing the hormones that are causing your cancer to grow.
Surgery — Minimally invasive surgery can also treat gynecologic cancers. This type of surgery requires several small incisions — or no incisions at all. Patients often heal faster and have fewer complications than those who undergo traditional surgery. It can be combined with brachytherapy in some cases.

What Are the Risks and Complications of HDR Gynecologic Brachytherapy?

HDR brachytherapy is used in part because it causes fewer side effects. However, complications and side effects are still possible. They include:

Lymphedema — Radiation in the pelvis can lead to blockages that cause fluid to build up in the legs. It is more common if brachytherapy is done with surgery to remove lymph nodes.
Premature menopause — Pelvic radiation can damage the ovaries, leading to premature menopause. This is not a concern if you have already reached menopause or if your ovaries were removed as part of your cancer surgery.
Radiation cystitis — Bladder irritation that can lead to problems urinating, the urge to urinate often, or blood in the urine.
Radiation proctitis — Bowel irritation that can cause bleeding.
Radiation vaginitis — Vaginal irritation that leads to discomfort and discharge.
Vaginal dryness — This is a common side effect of gynecological brachytherapy.
Weakened bones — Radiation in the pelvis can weaken bones. This can lead to fractures in the hips or pelvis.

What Should I Expect From HDR Gynecologic Brachytherapy?

What to expect from HDR brachytherapy depends on which type you receive — interstitial or intracavitary.

How to prepare for HDR gynecologic brachytherapy

Interstitial brachytherapy

For interstitial brachytherapy, you will need to prepare for a hospital stay. Providers typically give radiation treatment one to two times per day for three or four days.

Your provider will likely do a pelvic exam before the procedure. They may order blood work, x-rays, or an electrocardiogram (EKG).

Intracavitary brachytherapy

For intracavitary brachytherapy, your provider will schedule a simulation or treatment planning session. During the simulation, your provider will take measurements and place the applicator into your vagina. You may then have a CT scan or an MRI to confirm the correct placement of the applicator.

How long does HDR gynecologic brachytherapy take?

Interstitial brachytherapy requires surgical placement of an applicator and occurs over several days. You must stay in the hospital during that time. Each radiation session takes about 10 to 20 minutes. Once you leave the hospital, your treatment is over.

An intracavitary brachytherapy session takes 10 to 20 minutes. This kind of brachytherapy must be repeated over several sessions.

During your HDR gynecologic brachytherapy

Interstitial brachytherapy

When you arrive at the hospital for interstitial brachytherapy, you will be taken to the operating room. You will be put under general anesthesia so your provider can place your applicators. Your applicators may be soft plastic tubes, thin metal rods, or needles, depending on the type of tumor.

First, your provider will insert a catheter into your bladder because you will not be able to move around once the applicators are in place. You may also receive an epidural. This will numb you from the waist down and help control pain during your hospital stay.
Then, your doctor will place the applicators in and around your tumor by going through the vagina or making incisions in the abdomen. The applicators will not yet contain radioactive material. This occurs during your treatment session.
For each radiation treatment session, your applicators are attached to a machine. This machine will load radioactive material into the applicators for 10 to 20 minutes, then remove it at the end of the session. You will need to be in the room alone so that others are not exposed to radiation.
Between each radiation session, you must remain in bed. You may be given a special diet, medication to slow your bowels, and blood thinners to prevent blood clots. The treatment does not make you radioactive, so it’s safe to have visitors.
After your last session, your doctor will remove the applicators, catheter, and epidural.

Intracavitary brachytherapy

When you arrive for intracavitary brachytherapy, you will first need to use the restroom and completely empty your bladder. Then, much like you would for a pelvic exam, you will remove your clothes from the waist down, cover yourself with a sheet, lie down, and place your feet in stirrups so the treatment can begin.

A nurse or radiation therapist will place the applicator into your vagina and connect the applicator to a machine.
Once everyone has left the room to avoid radiation exposure, the machine will place a tube inside your applicator. This tube contains the radioactive material. It does not touch you and does not make you radioactive.
After 10 to 20 minutes, the machine will remove the radioactive material from your applicator. Your doctor will then remove your applicator, and you can go home.

Recovery after HDR gynecologic brachytherapy

Interstitial brachytherapy

After your treatments are over and your applicators are removed, you may experience some weakness and dizziness because you’ve been in bed for so many days. Before discharge, you will need to walk without help, keep food and liquids down, and urinate.

Once you are home, you are likely to be very tired and sore around your incisions. Your provider will tell you when you can return to your normal activities.

Intracavitary brachytherapy

After your treatment, you may be sore and have a small amount of bleeding from your vagina.

When to call your doctor about problems following HDR gynecologic brachytherapy

You should call your provider if you experience any of the following symptoms:

Abnormal bleeding.
Fever or chills.
Severe discomfort in the pelvic area.
Sudden shortness of breath or chest pain. If this occurs and you cannot speak with your doctor, go directly to the nearest emergency department.

How effective is brachytherapy?

According to a study published in the International Journal of Radiation Oncology, patients with cervical cancer who received intracavitary HDR brachytherapy had a five-year survival rate between 62% and 88%. The rate depended on the stage of cancer, with earlier-stage cancers having better survival rates.

Why Choose UPMC for HDR Gynecologic Brachytherapy?

UPMC provides expert care for gynecologic cancer. At UPMC, you can expect:

Compassionate care — At UPMC, you're not alone in your fight against gynecologic cancer. Our team will provide you with the latest advancements in cancer care. They also will guide and support you through diagnosis, treatment, and survivorship.
Locations close to home — We offer gynecologic oncology services in communities across the region. You won’t have to travel far from home to receive the world-class care you need.
National recognition — UPMC Hillman Cancer Center is one of just 57 National Cancer Institute-designated Comprehensive Cancer Centers in the country — and the only one in western Pennsylvania. The designation isn’t just an accolade. It’s an assurance that your cancer treatment is grounded in the latest advances in clinical care and supported by evidence-based research.
Top doctors — Nearly 500 UPMC physicians have been recognized as “Top Doctors” across more than 60 different specialties, including gynecologic oncology.

By UPMC Editorial Staff. Last reviewed on 2026-08-06.

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