Radiation therapy plays a very important role in the treatment of cervical cancer. Regarding the past life and present life of radiation therapy for cervical cancer, the following are some truths that you have to know.
I. How long is the history of radiotherapy for cervical cancer?
The history of radiation therapy for cervical cancer began more than 100 years ago. It first started in 1902, when some experts began using X-rays to treat cervical cancer. A year later, radium began to be used to treat cervical cancer. In the early days of radiotherapy for cervical cancer, the technology level was not as advanced as now, and many obstacles were encountered while accumulating experience, such as: not knowing how the radiation biological effect of normal tissues and tumors; little understanding of the dose distribution of normal tissues and tumors; most of the time, treatment was based on experience, and radiotherapy failure and complications were relatively common, etc.
What are the latest advances in radiotherapy for cervical cancer?
After more than a century of technological development, radiotherapy for cervical cancer has made great progress today. The introduction of imaging technology into intracavitary radiotherapy has brought revolutionary changes to the technology of intracavitary radiotherapy, mainly in the determination of target volume based on 3D imaging and the setting of 3D imaging-based treatment plan, of which TOMO is one of the representatives, with the design of treatment plan and dose distribution map. 3D intracavitary radiation therapy for cervical cancer has obvious advantages compared with conventional radiation treatment plans. In the past, we used 2D treatment, i.e., the volume dose was represented by the dose of a single point, which had a major drawback; with the application of 3D radiation therapy, a good dose distribution map can be given for different cervical cancer types. This new technology will bring great changes to the work of radiologists, and the biology of 3D intracavitary radiation therapy for cervical cancer needs more research.
Third, can radiotherapy alone cure cervical cancer?
The view that “radiotherapy is only adjuvant and a helpless solution for those who cannot be operated” does not apply to radiotherapy for cervical cancer. Surgery is only applicable to patients with pre-stage IIa. However, radiotherapy for cervical cancer has a wide range of indications, and some cervical cancers can be cured by radiotherapy alone. Only cervical cancer patients are mostly people with limited knowledge and less than ideal economic and health conditions, which also leads to the fact that once cervical cancer is diagnosed, it is often at an advanced stage of the disease and misses the best treatment period, while radiotherapy gives them more hope to live on.
How to choose “internal and external radiotherapy” for cervical cancer radiotherapy?
Due to the special physiological structure of women, there is a vagina which is naturally connected with the outside world, radiotherapy for cervical cancer can be divided into “internal radiotherapy” and “external radiotherapy”, which are also called “intracavitary radiotherapy” and “external radiotherapy”. It is also called “intracavitary radiotherapy” and “extracavitary radiotherapy”, or “brachytherapy” and “distant radiotherapy”. “External radiotherapy” is external radiation therapy, which means radiation is irradiated through the belly. “Internal radiotherapy” refers to in vivo radiotherapy, in which the radioactive material is placed inside the body to irradiate the tumor directly.
Generally speaking, “external radiotherapy” can take care of the whole pelvis, including the uterus, lymph nodes, parametrium lesions, and so on. The efficacy of “internal radiotherapy” is inversely proportional to the square of the distance, the closer the effect, the better the effect. In early stage of cervical cancer, the tumor is mainly localized and the lesions are relatively small, so in most cases, “internal radiotherapy” is the main treatment and “external radiotherapy” is supplementary. In advanced stage, the tumor has gone beyond the cervix, involving the parametrium or the lower end of the vagina, and the lesions are very extensive. At this time, radiotherapy should be given mainly outside the body and supplemented inside the body.
V. Do I need to synchronize chemotherapy with radiotherapy?
For patients with advanced cervical cancer, synchronization of radiotherapy and chemotherapy can benefit patients more. Currently, there are 5 prospective studies with a total of 1984 patients enrolled. Compared with radiotherapy alone, synchronized radiotherapy and chemotherapy have significantly lower recurrence and mortality rates, and the relative risk is reduced by 30% to 50%. All patients with cervical cancer requiring radiotherapy who received radiotherapy along with cisplatin-based chemotherapy significantly improved their prognosis. In addition, other studies found that the 5-year survival rate was 58% in the radiotherapy group and 73% in the radiotherapy plus chemotherapy group for advanced cervical cancer; for locally advanced cervical cancer, simultaneous radiotherapy and chemotherapy can significantly improve the prognosis.
What are the key factors affecting the effect of radiotherapy for cervical cancer?
The key factors are mainly the following four points.
1. whether adequate irradiation of the target area is achieved, including volume and intensity.
2.The total treatment time should be limited to 56 days.
3, the use of brachytherapy.
4, the use of radiotherapy with simultaneous chemotherapy.
Five relevant prospective studies found that synchronization of radiotherapy and chemotherapy was associated with a significant reduction in recurrence and morbidity and mortality rates and a 30% to 50% reduction in relative risk compared with radiotherapy alone. All cervical cancer patients who need radiotherapy can significantly improve their prognosis if they receive radiotherapy together with cisplatin-based chemotherapy.
7.How to choose radiotherapy for cervical cancer?
In case of postoperative cervical cancer, intensity-modulated radiotherapy should be emphasized; in case of radical treatment, image-guided precise intensity-modulated radiotherapy is recommended; in case of intracavitary irradiation, image-guided two-dimensional intracavitary radiotherapy or image-guided three-dimensional precise radiotherapy can be used. We also expect better treatment results to emerge.