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Radiotherapy in Cervical Cancer

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Abstract

Cervical Cancer is one of the most common types of cancer in the female Mexican population, and unfortunately, in almost half of all cases, the patient presents with locally advanced clinical stage, therefore being familiar with all radiotherapy techniques is crucial in order to give our patients the best possible outcome. Stage by stage the possibilities with radiotherapy treatment are so many: from conformal radiotherapy to the most modern techniques such as stereotaxic radiotherapy and IMRT are tools that we can use depending on the clinical scenario, and all those type of treatments are described and discussed in this chapter. What is the most important thing to remember is that every patient is a different case and we always have to individualize treatment to get best results.

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References

  1. Kielbinska S, Ludwika T, Fraczek O. Studies of mortality and health status in women cured of cancer of the cervix uteri: comparison of long-term results of radiotherapy and combined surgery and radiotherapy. Cancer. 1973;32:245–52. doi:10.1002/1097-0142(197307)32:1<245.

    Article  Google Scholar 

  2. Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, Favini G, Ferri L, Mangioni C. Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet. 1997;350:535–40. doi:10.1016/S0140-6736(97)02250-2.

    Article  CAS  PubMed  Google Scholar 

  3. Delgado G, Bundy B, Zaino R, Sevin BU, Creasman WT, Major F. Prospective surgi- cal–pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 1990;38(3):352–7. PMID: 2227547

    Article  CAS  PubMed  Google Scholar 

  4. Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ. A Randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenect- omy: a Gynecologic Oncology Group Study. Gynecol Oncol. 1999;73(2):177–83. doi:10.1006/gyno.1999.5387.

    Article  CAS  PubMed  Google Scholar 

  5. Rotman M, Sedlis A, Piedmonte MR, Bundy B, Lentz SS, Muderspach LI, Zaino RJ. A phase III randomized trial of postop- erative pelvic irradiation in Stage IB cervical carcinoma with poor prognostic fea- tures: follow-up of a Gynecologic Oncology Group study. Int J Radiat Oncol Biol Phys. 2006;65(1):169–76. doi:10.1016/j.ijrobp.2005.10.019.

    Article  PubMed  Google Scholar 

  6. Peters 3rd WA, Liu PY, Barrett 2nd RJ, Stock RJ, Monk BJ, Berek JS, Souhami L, Grigsby P, Gordon Jr W, Alberts DS. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000;18(8):1606–13. PMID: 10764420

    Article  CAS  PubMed  Google Scholar 

  7. Carballo N, González-Cortijo L, González-Martín A, Rojo A, Chiva L. Indications for adjuvant radiotherapy treatment after surgery and novel modalities for treatment. Gynecol Oncol. 2008;110(3 Suppl 2):S41–4. doi:10.1016/j.ygyno.2008.07.009.

    Article  CAS  PubMed  Google Scholar 

  8. Sehouli J, Runnebaum IB, Fotopoulou C, Blohmer U, Belau A, Leber H, Hanker LC, Hartmann W, Richter R, Keyver-Paik MD, Oberhoff C, Heinrich G, du Bois A, Olbrich C, Simon E, Friese K, Kimmig R, Boehmer D, Lichtenegger W, Kuemmel S. A randomized phase III adjuvant study in high-risk cervical cancer: simultaneous radiochemotherapy with cisplatin (S-RC) versus systemic paclitaxel and carboplatin followed by percutaneous radiation (PC-R): a NOGGO-AGO Intergroup Study. Ann Oncol. 2012;23:2259–64. doi:10.1093/annonc/mdr628.

    Article  CAS  PubMed  Google Scholar 

  9. Version 1. National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology, cervical cancer. 2015.

    Google Scholar 

  10. Small W, Mell LK, Anderson P, Cruetzberg C, De Los Santos J, De Los Santos J, Gaffney D, Jhingran A, Portelance L, Schefter T, Iyer R, Varia M, Winter K, Mundt AJ. Consensus guidelines for delineation of CTV for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer. Int J Radiat Oncol Biol. 2008;71(2):428–34. doi:10.1016/j.ijrobp.2007.09.042.

    Article  Google Scholar 

  11. Haie-Meder C, Potter R, Van Limbergen E, Briot E, De Brabandere M, Dimopoulos J, Dumas I, Hellebust TP, Kirisits C, Lang S, Muschitz S, Nevinson J, Nulens A, Petrow P, Wachter-Gerstner N, Gynaecological (GYN) GEC-ESTRO Working Group. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): Concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol. 2005;74(3):235–45. doi:10.1016/j.radonc.2004.12.015.

    Article  PubMed  Google Scholar 

  12. Primer consenso nacional de prevención, diagnóstico y tratamiento del cáncer cervicouterino . Gaceta Mexicana de Oncología. 2014;13(Suppl 4):1–3.

    Google Scholar 

  13. Rose PG, Bundy BN, Watkins EB, Tate Thigpen J, Deppe G, Maiman MA, Clarke-Pearson DL, Insalaco S. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. New Engl J Med. 1999;340:1144–53. doi:10.1056/NEJM199904153401502.

    Article  CAS  PubMed  Google Scholar 

  14. Whitney CW, Sause W, Bundy BN, Malfetano JH, Hannigan EV, Fowler Jr WC, Clarke-Pearson DL, Liao SY. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIb-IVa carcinoma of the cervix with negative para-aortic lymph nodes: a gynecologic oncology group and southwest oncology group study. J Clin Oncol. 1999;17:1339–48. PMID: 10334517

    Article  CAS  PubMed  Google Scholar 

  15. Morris M, Eifel P, Lu J, Grigsby PW, Levenbac C, Stevens RE, Marvin Rotman MD, Gershenson DM, Mutch DG. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med. 1999;340:1137–4. doi:10.1056/NEJM199904153401501.

    Article  CAS  PubMed  Google Scholar 

  16. Keys HM, Bundy BN, Stehman FB, Muderspach LI, Chafe WE, Suggs CL, Walker JL, Gersell D. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med. 1999;340:1154–61. doi:10.1056/NEJM199904153401503.

    Article  CAS  PubMed  Google Scholar 

  17. Peters 3rd WA, Liu PY, Barrett 2nd RJ, Stock RJ, Monk BJ, Berek JS, Souhami L, Grigsby P, Gordon Jr W, Alberts DS. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 18:1606–13. PMID: 10764420

    Google Scholar 

  18. Fu KK. Biological basis for the interaction of chemotherapeutic agents and radiation therapy. Cancer. 1985;55(9 Suppl):2123–30. PMID: 3884135

    Article  CAS  PubMed  Google Scholar 

  19. Eifel PJ, Winter K, Morris M, Levenback C, Grigsby PW, Cooper J, Rotman M, Gershenson D, Mutch DG. Pelvic Irradiation With Concurrent Chemotherapy Versus Pelvic and Para-Aortic Irradiation for High-Risk Cervical Cancer: An Update of Radiation Therapy Oncology Group Trial (RTOG) 90-01. J Clin Oncol. 2004;22:872–80. doi:10.1200/JCO.2004.07.197.

    Article  PubMed  Google Scholar 

  20. Van de Bunt L, van der Heide UA, Ketelaars M, de Kort GA, Jürgenliemk-Schulz IM. Conventional, conformal, and intensity-modulated radiation therapy treatment planning of external beam radiotherapy for cervical cancer: The impact of tumor regression. Int J Radiat Oncol Biol Phys. 2006;64(1):189–96. doi:10.1016/j.ijrobp.2005.04.025.

    Article  PubMed  Google Scholar 

  21. Van de Bunt L, Jurgenliemk-Schulz IM, de Kort GA, Roesink JM, Tersteeg RJ, van der Heide UA. Motion and deformation of the target volumes during IMRT for cervical cancer: What margins do we need? Radiother Oncol. 2008;88(2):233–40. doi:10.1016/j.radonc.2007.12.017.

    Article  PubMed  Google Scholar 

  22. Taylor A, Powell ME. An assessment of interfractional uterine and cervical motion: implications for radiotherapy target volume definition in gynecological cancer. Radiother Oncol. 2008;88(2):250–7. doi:10.1016/j.radonc.2008.04.016.

    Article  PubMed  Google Scholar 

  23. Haas JA, Witten MR, Clancey O, Episcopia K, Accordino D, Chalas E. CyberKnife Boost for Patients with Cervical Cancer Unable to Undergo Brachytherapy. Front Oncol. 2012;2:25. doi:10.3389/fonc.2012.00025.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Petterson F. Annual report of the results of treatment in gynecologic cancer (FIGO). Int J Gynecol Obstet. 2006;95(sup 1):23. doi:http://dx.doi.org/10.1016/S0020-7292(06)60043-X

  25. Delgado G. Stage IB squamous cancer of the cervix: the choice of treatment. Obstet Gynecol Surv. 1978;33:174–83. PMID: 343017

    Article  CAS  PubMed  Google Scholar 

  26. Chung CK, Nahhas WA, Stryker JA, Curry SL, Abt AS, Mortel R. Analysis of factors contributing to treatment failure in stage IB and IIA carcinoma of the cervix. Am J Obstet Gynecol. 1980;138(5):550–6. doi:10.1016/0002-9378(80)90285-9.

    Article  CAS  PubMed  Google Scholar 

  27. Boyce J, Fruchter RG, Nicastri A, Ambiavagar P, Reinis MS, Nelson J. Prognostic factors in stage I carcinoma of the cervix. Gynecol Oncol. 1981;12:154–65. PMID: 7297927

    Article  CAS  PubMed  Google Scholar 

  28. Van Nagell JR, Donaldson ES, Parker J. The significance of vascular invasion and lymphocytic infiltration in invasive cervical cancer. Cancer. 1978;41(1):228–34. PMID: 626931

    Article  PubMed  Google Scholar 

  29. Abdulhayoglu S, Rich WM, Reynold J, DiSaia PJ. Selective radiation therapy in Stage IB uterine cervical carcinoma following radical pelvic surgery. Gynecol Oncol. 1980;10(1):84–92. doi:10.1016/0090-8258(80)90068-2.

    Article  CAS  PubMed  Google Scholar 

  30. Boyce J, Fruchter R, Nicastri AD, De Regt R, Ambiavagar P, Reinis M, Macassaet M, Rotman M. Vascular invasion in stage I carcinoma of the cervix. Cancer. 1984;53:1175–80. doi:10.1002/1097-0142(19840301)53:5<1175::AID-CNCR2820530524>3.0.CO;2-Y.

    Article  CAS  PubMed  Google Scholar 

  31. Wang X, Liu R, Ma B, Yang K, Tian J, Jiang L, Bai ZG, Hao XY, Wang J, Li J, Sun SL, Yin H. High dose rate versus low dose rate intracavity brachytherapy for locally advanced uterine cervix cancer. Cochrane Database Syst Rev. 2010;7(7):CD007563. doi:10.1002/14651858.CD007563.pub2.

    Google Scholar 

  32. Halperin Edward C, Pérez C, et al. Endometrial cáncer. In: Pérez and Brady’s principles and practice of radiation oncology. 6th ed. Copyright 2013. p. 1426–48.

    Google Scholar 

  33. Lertsanguansinchai P, Lertbutsayanukul C, Shotelersuk K, Khorprasert C, Rojpornpradit P,Chottetanaprasith T, Srisuthep A, Suriyapee S, Jumpangern C, Tresukosol D, Charoonsantikul C (2004) Phase III Randomized trial comparing LDR and HDR brachytherapy in treatment of cervical carcinoma. Int J Radiat Oncol Biol Phys 59 (5)1424–1431. doi: 10.1016/j.ijrobp.2004.01.034

  34. Viswanathan AN, Thomadsen B, American Brachytherapy Society Cervical Cancer Recommendations Committee; American Brachytherapy Society. American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part I: General principles. Brachytherapy. 2012;11(1):33–46. doi:10.1016/j.brachy.2011.07.003.

    Article  PubMed  Google Scholar 

  35. Viswanathan AN, Beriwal S, De Los Santos JF, Demanes DJ, Gaffney D, Hansen J, Jones E, Kirisits C, Thomadsen B, Erickson B, American Brachytherapy Society. American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part II: High-dose-rate brachytherapy. Brachytherapy. 2012;11(1):47–52. doi:10.1016/j.brachy.2011.07.002.

    Article  PubMed  PubMed Central  Google Scholar 

  36. International Commission of Radiation Units and Mea- surements. Dose and volume specifications for reporting intracavitary therapy in gynecology. ICRU Report 38. Bethesda: International Commission on Radiation Units; 1985.

    Google Scholar 

  37. Nag S, Erickson B, Thomadsen B, Orton C, Demanes JD, Petereit D. The American Brachytherapy society recommendations for high-Dose-Right brachytherapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys. 2000;48(1):201–11. PMID: 10924990

    Article  CAS  PubMed  Google Scholar 

  38. Viswanathan A, Erickson B. Seeing is saving: the benefit of 3D imaging in gynecologic brachytherapy. Gynecol Oncol. 2015;138:207–15. doi:10.1016/j.ygyno.2015.02.025.

    Article  PubMed  Google Scholar 

  39. Xiang- E, Shu-mo C, Ya-qin D, Ke W. Treatment of late recurrent vaginal malignancy after initial radiotherapy for carcinoma of the cervix: an analysis of 73 cases. Gynecol Oncol. 1998;69:125–9. doi:10.1006/gyno.1998.4975.

    Article  Google Scholar 

  40. National Institute of Health. NCI issues clinical announcement on cervical cancer: chemotherapy plus radiation improves survival. 22 Feb 1999. Article 01826.

    Google Scholar 

  41. Georg P, Potter R, Georg D, Lang S, Dimopoulos JC, Sturdza AE, Berger D, Kirisits C, Dörr W. Dose effect relationship for late side effects of the rectum and urinary bladder in magnetic resonance image-guided adaptive cervix cancer brachytherapy. Int J Radiat Oncol Biol Phys. 2012;82(2):653–7. doi:10.1016/j.ijrobp.2010.12.029.

    Article  PubMed  Google Scholar 

  42. Georg P, Boni A, Ghabuous A, Goldner G, Schmid MP, Georg D, Pötter R, Dörr W. Time course of late rectal- and urinary bladder side effects after MRI-guided adaptive brachytherapy for cervical cancer. Strahlenther Onkol. 2013;189:535–40. doi:10.1007/s00066-013-0365-7.

    Article  CAS  PubMed  Google Scholar 

  43. Eifel PJ, Levenback C, Wharton JT, Oswald MJ. Time course and incidence of late complications in patients treated with radiation therapy for FIGO stage IB carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys. 1995;32(5):1289–300. doi:10.1016/0360-3016(95)00118-I.

    Article  CAS  PubMed  Google Scholar 

  44. Lorvidhaya V, Tonusin A, Changwiwit W, Chitapanarux I, Srisomboon J, Wanwilairat S, Chawapun N, Sukthomya V. High-dose-rate afterloading brachytherapy in carcinoma of the cervix: an experience of 1992 patients. Int J Radiat Oncol Biol Phys. 2000;46:1185–91. PMID: 10725630

    Article  CAS  PubMed  Google Scholar 

  45. Charra-Brunaud C, Harter V, Delannes M, Haie-Meder C, Quetin P, Kerr C, Castelain B, Thomas L, Peiffert D. Impact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France: results of the French STIC prospective study. Radiother Oncol. 2012;103(3):305–13. doi:10.1016/j.radonc.2012.04.007.

    Article  PubMed  Google Scholar 

  46. Mitchell PA, Waggoner S, Rotmensch J, Mundt AJ. Cervical cancer in the elderly treated with radiation therapy. Gynecol Oncol. 1998;71(2):291–8. doi:10.1006/gyno.1998.5180.

    Article  CAS  PubMed  Google Scholar 

  47. Perez CA, Grigsby PW, Lockett MA, Chao KS, Williamson J. Radiation therapy morbidity in carcinoma of the uterine cervix: dosimetric and clinical correlation. Int J Radiat Oncol Biol Phys. 1999;44(4):855–66. PMID: 10386643

    Article  CAS  PubMed  Google Scholar 

  48. Eifel PJ, Jhingran A, Bodurka DC, Levenback C, Thames H. Correlation of smoking history and other patient characteristics with major complications of pelvic radiation therapy for cervical cancer. J Clin Oncol. 2002;20(17):3651–7. PMID: 12202666

    Article  PubMed  Google Scholar 

  49. Perez CA, Breaux S, Bedwinek JM, Madoc-Jones H, Camel HM, Purdy JA, Walz BJ. Radiation therapy alone in the treatment of carcinoma of the uterine cervix II. Analysis of complications. Cancer. 1984;54(2):235–46. PMID: 6722748

    Article  CAS  PubMed  Google Scholar 

  50. Mauch P, Constine L, Greenberger J, Knospe W, Sullivan J, Liesveld JL, Deeg HJ. Hematopoietic stem cell compartment: acute and late effects of radiation therapy and chemotherapy. Int J Radiat Oncol Biol Phys. 1995;31(5):1319–39. doi:10.1016/0360-3016(94)00430-S.

    Article  CAS  PubMed  Google Scholar 

  51. Small Jr W, Winter K, Levenback C, Iyer R, Hymes SR, Jhingran A, Gaffney D, Erickson B, Greven K. Extended-field irradiation and intracavitary brachytherapy combined with cisplatin chemotherapy for cervical cancer with positive para-aortic or high common iliac lymph nodes: results of ARM 1 of RTOG 0116. Int J Radiat Oncol Biol Phys. 2007;68(4):1081–7. doi:10.1016/j.ijrobp.2007.01.026.

    Article  CAS  PubMed  Google Scholar 

  52. Kirwan JM, Symonds P, Green JA, Tierney J, Collingwood M, William CJ. A systematic review of acute and late toxicity of concomitant chemoradiation for cervical cancer. Radiother Oncol. 2003;68(3):217–26. PMID: 13129628

    Article  PubMed  Google Scholar 

  53. Chemoradiation for Cervical Cancer Meta-Analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol. 2008;26:5802–12.

    Article  Google Scholar 

  54. Chemoradiation for Cervical Cancer Meta-Analysis Collaboration (CCCMAC). Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: individual patient data meta-analysis [serial online]. Cochrane Database Syst Rev. 2010;20(1):CD008285. doi:10.1002/14651858.CD008285.

    Google Scholar 

  55. Viswanathan AN, Lee LJ, Eswara JR, Horowitz NS, Konstantinopoulos PA, Mirabeau-Beale KL, Rose BS, von Keudell AG, Wo JY. Complications of pelvic radiation in patients treated for gynecologic malignancies. Cancer. 2014;120(24):3870–83. doi:10.1002/cncr.28849.

    Article  PubMed  Google Scholar 

  56. Gandhi AK, Sharma DN, Rath GK, Julka PK, Subramani V, Sharma S, Manigandan D, Laviraj MA, Kumar S, Thulkar S. Early clinical outcomes and toxicity of intensity modulated versus conventional pelvic radiation therapy for locally advanced cervix carcinoma: a prospective randomized study. Int J Radiat Oncol Biol Phys. 2013;87(3):542–8. doi:10.1016/j.ijrobp.2013.06.2059.

    Article  PubMed  Google Scholar 

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Mota-García, A., Blake-Cerda, M., Ramón-Ortega, B., Guadarrama-Fleites, R.A., Trejo-Durán, G.E. (2017). Radiotherapy in Cervical Cancer. In: de la Garza-Salazar, J., Morales-Vásquez, F., Meneses-Garcia, A. (eds) Cervical Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-45231-9_12

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