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vagina.","sessions_or_stages":{"sessions":{"min":2,"max":3,"unit":"visits","qualifier":"Vaginal cuff HDR usually 2-3 fractions; intracavitary courses may be longer."},"stages":[{"code":"applicator_planning","label":"Applicator placement and imaging-based planning","after":{"min":0,"max":0,"unit":"days","qualifier":"First fraction."}},{"code":"radiation_delivery","label":"HDR radiation delivery and applicator removal","after":{"min":0,"max":0,"unit":"days","qualifier":"Same day as placement."}},{"code":"repeat_fractions","label":"Remaining fractions with repeat placement","after":{"min":3,"max":14,"unit":"days","qualifier":"Twice weekly or weekly, depending on schedule."}}],"qualifier":"Vaginal cuff HDR is usually a standalone course after hysterectomy; brachytherapy only."},"success":{"metric":"Vaginal control (no vaginal vault recurrence)","value":95,"unit":"percent","horizon":"5 years","population":"Endometrial cancer after hysterectomy with adjuvant vaginal cuff brachytherapy","evidence_status":"limited"},"techniques":[{"name":"HDR vaginal cylinder (vaginal cuff)","suits_whom":"Endometrial cancer after hysterectomy; standard adjuvant approach","recovery":"Day procedure per fraction; minimal recovery"},{"name":"HDR intrauterine tandem with ovoid or ring","suits_whom":"Medically inoperable endometrial cancer with uterus in situ","recovery":"Day procedure per fraction; mild cramping"},{"name":"Combined intracavitary-interstitial HDR","suits_whom":"Bulky uterine or vaginal disease needing better dose shaping","recovery":"Longer anesthesia; more pelvic soreness"},{"name":"LDR or pulsed-dose-rate brachytherapy","suits_whom":"Selected patients in centers still using it","recovery":"Inpatient stay of 1-3 days with bed rest"}],"treatment_conditions":["outpatient","day_case"],"treatment_duration_hours":{"min":1,"max":3,"unit":"hours","qualifier":"Per fraction, including preparation, planning and a few minutes of radiation delivery."},"initial_assessment_documents":["Endometrial biopsy and pathology report","Pelvic MRI report and images","Chest-abdomen-pelvis CT report","Surgical report and final pathology","Oncologist treatment plan or tumor board summary"],"travel_trips":{"min":1,"max":1,"one_trip_possible":true,"qualifier":"Vaginal cuff fractions fit one 1-2 week stay; one trip covers all."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Ask whether a doctor is always present in the clinic and whether a high dependency or intensive care unit exists","scope":"treatment_abroad","source":{"url":"https://www.bapras.org.uk/public/patient-information/cosmetic-surgery/cosmetic-surgery-abroad","host":"bapras.org.uk","quote":"Is there always a doctor in the clinic and is there a high dependency or intensive care unit?","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C2","text":"Check that the clinic gives written aftercare instructions and contact details for advice about side effects","scope":"procedure","source":{"url":"https://www.plymouthhospitals.nhs.uk/display-pil/pil/intrauterine-brachytherapy-7105/","host":"plymouthhospitals.nhs.uk","quote":"You will be given an aftercare leaflet with contacts for the Brachytherapy team and instructions with who to contact if you need advice or help afterwards with any side effects.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"C3","text":"Ask for certification information and the name of the body that certified the surgical setting","scope":"treatment_abroad","source":{"url":"https://www.isaps.org/discover/patients-home/considering-your-procedure-abroad/finding-a-surgeon-abroad/","host":"isaps.org","quote":"Ask for certification information and the name of the certifying body when assessing a surgical setting.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C4","text":"Check that the surgeon who consults with you is the same person who will carry out the procedure","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Check that the surgeon you consult with, will be the same person carrying out the procedure.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C5","text":"Expect two consultations with the treating surgeon before any surgery, which also gives you time to reconsider","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery-abroad/","host":"nhs.uk","quote":"You should have 2 consultations with the surgeon treating you before any surgery.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-12","next_check_at":"2027-11-12","version":1},"red_flags":{"status":"ok","items":[{"id":"F1","text":"An advert or information that guarantees complete success should raise concerns","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Any advert or information that guarantees complete success should raise concerns.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"F2","text":"Forceful persuasion or cheap, time-limited offers pushing you into a quick decision","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Don’t be pressured into quick decisions either through forceful persuasion or cheap, time limited offers.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"F3","text":"A price that sounds too good to be true probably is","scope":"treatment_abroad","source":{"url":"https://www.plasticsurgery.org/news/articles/will-economic-uncertainty-drive-more-patients-overseas-for-plastic-surgery-what-to-consider-and-how-to-stretch-your-dollar-back-home","host":"plasticsurgery.org","quote":"If the price sounds too good to be true, it probably is.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-12","next_check_at":"2027-11-12","version":1},"warning_signs":{"status":"ok","items":[{"id":"W1","text":"Uncontrollable diarrhea","urgency":"contact_clinic","general":false,"source":{"url":"https://www.christie.nhs.uk/your-treatment-and-care/treatments/radiotherapy/types-of-radiotherapy-we-offer/radiotherapy-for-gynaecological-cancers","host":"christie.nhs.uk","quote":"If, while you are at home, the side effects become severe such as uncontrollable diarrhoea, heavy bleeding, difficulty in passing urine, fever, severe tiredness or pain, it is important to contact The Christie Hotline 0161 446 3658 which is open 24 hours a day, 7 days a week for advice.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"W2","text":"Difficulty passing urine","urgency":"contact_clinic","general":false,"source":{"url":"https://www.christie.nhs.uk/your-treatment-and-care/treatments/radiotherapy/types-of-radiotherapy-we-offer/radiotherapy-for-gynaecological-cancers","host":"christie.nhs.uk","quote":"If, while you are at home, the side effects become severe such as uncontrollable diarrhoea, heavy bleeding, difficulty in passing urine, fever, severe tiredness or pain, it is important to contact The Christie Hotline 0161 446 3658 which is open 24 hours a day, 7 days a week for advice.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"W3","text":"Fever","urgency":"contact_clinic","general":true,"source":{"url":"https://www.christie.nhs.uk/your-treatment-and-care/treatments/radiotherapy/types-of-radiotherapy-we-offer/radiotherapy-for-gynaecological-cancers","host":"christie.nhs.uk","quote":"If, while you are at home, the side effects become severe such as uncontrollable diarrhoea, heavy bleeding, difficulty in passing urine, fever, severe tiredness or pain, it is important to contact The Christie Hotline 0161 446 3658 which is open 24 hours a day, 7 days a week for advice.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}}],"checked_at":"2026-11-12","next_check_at":"2027-11-12","version":1},"take_home":{"status":"ok","items":[{"id":"T1","text":"Home doctor needs the clinic's follow-up recommendations in a written discharge summary","document":"discharge 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internal radiation","name":"External beam radiotherapy","source":{"url":"https://www.clatterbridgecc.nhs.uk/patients-and-visitors/our-services/womb-cancer","host":"clatterbridgecc.nhs.uk","quote":"External beam radiotherapy – where radiation is delivered from outside the body.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":403},"operation_id":null}],"checked_at":"2026-11-12","next_check_at":"2027-11-12","version":1},"technique_details":{"status":"ok","items":[{"id":"hdr-vaginal-cylinder","name":"HDR vaginal cylinder (vaginal cuff)","how_it_works":{"status":"missing","reason":"no_official_source"},"recovery_daily":{"status":"missing","reason":"no_official_source"}},{"id":"hdr-intrauterine-tandem","name":"HDR intrauterine tandem with ovoid or ring","how_it_works":{"text":"Radioactive sources are placed in the womb or 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