RADIOTHERAPY IN GYNAECOLOGICAL

MALIGNANCY

Dr Ramesh Kothari
DMRT, MDRT (Manipal University)
Sanjeevni CBCC USA Cancer Hospital, Raipur

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BA-BA MEDICINE

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• Multiparous.
• Low socioeconomic class.
• Poor hygiene.
• Prostitutes.
• Low incidence in Muslims and Jews.

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• Fitness of the patients
• Age of the patients
• Stage of disease.
• Type of lesion
• Experience and the resources avalible.

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• Very bulky disease
• With paraaortic node
• Stage IV A disease[bladder and rectum
inv.]
• 2cycle NACT-f/b radiation

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• DIMENSION
• DEEP STROMAL INVASION
• PARAMETRIUM INVOLVEMENT
• CUT MARGIN
• LYMPHOVASCULAR INVOLVEMENT
• LYMPHNODAL INVOLVEMENT

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D DIMENSION->2cm
D DEPTH-DEEP
L LVI

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• Mediacally inoperable
• Stage II-IV disease

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• It allows presentation ofthe ovaries
(radiotherapy will destroythem).
• There is better chance of preservingsexual
function.
• (vaginal stonosis occur in up 85% of irradiates.
• Psychological feeling of removing the disease
from the body .
• More accurate staging and prognosis
• Glandular tumours (adenocarcinomas) are not
detectable by screening are associated with
skip lesions and require radical surgery.
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• Lymph node involvement is a major prognostic
factor in cervical carcinoma, lymphatic spread of
cervical cancer has been one of the most studied
surgical topics in gynecologic oncology
• To date, the mainstay of detecting lymph node
metastasis is still the histologic evaluation,
• Therefore a proper resection of mostly involved
lymph nodes remains a crucial surgical step when
treating cervical cancer.

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• Haemorrhage: primary or secondary.
• Injury to the bladder,uerters.
• Bladder dysfunction.
• Fistula.
• Lymphocele.
• Shortening of the vagina.

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 Radiation toxicity
• Bladder related • Acute
• Rectum related • Late
• Bowel related

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 WHEN THINGS ARE
SUSPICIOUS PET CTIS
AUSPICIOUS

WHEN THINGS ARE

UNCLEAR THINK OF
NUCLEAR

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BRACHYTHERAPY TELETHERAPY
High dose to tumor tissue-Tumorcontrol
Normal tissue sparing
Minimize long and short term toxicities
Better Quality of life

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PLANNING
-IMMOBILIZATION

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Dr Santam Chakraborty Department of Radiotherapy, PGIMER Chandigarh
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• Uniform dose to simple shapes
• Circa 1930-1960

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 70 – 85 cm bore
 Scanning Field of View (SFOV) 48 cm –
60 cm – Allows wider separation to be
imaged.
 Multi slice capacity:
 Speed up acquistion times
 Reduce motion and breathing artifacts
 Allow thinner slices to be taken – better
DRR and CT resolution
 Allows gating capabilities
 Flat couch top – simulate treatment table

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 • Divides each treatment field into
multiple segments
• Modulates beam intensity,
giving discrete dose to each
segment
• Uses multiple, shaped beams
(~9) and thousands of segments
IMRT Initiated in 1995
Reached the clinic in 2000
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 Dosimetric comparision of bone marrow sparing IMRT (Lujan
et al):
• Found that between a dose level of 18 –


20 Gy a significant reduction in volume of bone marrow

 irradiated was obtained with IMRT.
• Brixey and Colleagues specifically compared hematological
toxicity of WP- IMRT vs WPRT in the setting of concurrent
CCT

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iView GT-Electa
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 First EPID

2 nd EPID

Ref image

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 1. Treatment procedure begins
 2. EPID LATDRR

 3. Online correction if needed

 4. 1st treatment
 5. Then treatment continues till completion
LATEPID
 6. EPIDcheckingweekly

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1. Both 3D CRT and IMRT are proven.
2. However unless dose escalation is done no
significant improvement in the control rates
should be expected.
3. Chronic and acute toxicity amelioration are the
more relevant endpoints.
4. Biologically optimized radiotherapy is an
exciting new development
5. Real impact can only be realised with meticulous
care in planning and execution.

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• 85Gy
• 50Gy EXTERNAL+BRACHY35Gy
• OVER6O DAYS

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HDR ICA
APPLICATORS

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Skeletal X-Ray

MRI

Bone scan

PET-CT

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• I. clinical Examination
– 3monthly for first 2year
– 6monthly for after 2year
– Annually there after
• II. No other investigations in asymptomatic
patients for early detection ofmetastasis, since it
is -
– Not cost-effective
– Does not prolong survival.
– Detection and disclosure of spread ofdisease may be
psychologically harmful to anasymptomatic

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With in 3 month followup
1. No pap smear/bx
2. Confusion about radiation changes
3. Unnecessary investigation
4. Anxiety
5. Unnecessary treatment

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• On completion of
treatment all
patients are given a
vaginal dilator to use
until vaginal mucosa
healed, this prevents
vaginal stenosis.
• Premenopausal
patients commenced
on HRT:

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