Radiotherapy to the female pelvis

Dr Sherif Raouf MB BCh FRCRConsultant Clinical Oncologist

BHRUT

How does radiotherapy works?

• Mechanism of action:

radiation induce damage of tumour cell DNA, preventing cell division and causing cell death

Radiotherapy uses

Curative indications:Cervical cancer 52% 5 yr OS.

Bladder cancerAnal cancer

Endometrial cancerRectal cancer

Palliative indications:Any tumour type for pain and symptom control

Procedure for giving radiotherapy

DiagnosisDiagnosis

Radiotherapy planningRadiotherapy planning

Treatment deliveryTreatment delivery

Radiotherapy planning

• Patient positioning– Lasers– Tattoos– Immobilisation

• To ensure reproducibility in a multi-fraction radiotherapy course

Positioning lasers

Radiotherapy side effects

Early (Acute):Occur during the course of the treatmentRecover soon after the therapy is completed

Late (chronic):late radiation complications are due to small vessel injury with endothelial damage, inflammation, fibrosis, ischaemia and necrosis.Occur months to years after a course of radiotherapyTend’s to be permanent …..

Early Radiotherapy side effects

FatigueSkin desquamationDiarrhoeaLow blood countFrequency / cystitis

Skin desquamation

Late side effects

• Skin telangectasia• Vaginal stenosis

• Dilators• Late effects on bowels

(proctitis)• Bladder changes• Avascular necrosis of the

hip• Secondary cancer

Sexual morbidity

Sexual problems suffered by women with cervical cancer may include:

loss of libido change in sexual activity and decreased orgasm.

Up to 65% of women experience one or more of these problems due to

vaginal dryness or bleeding.Vaginal stenosis and dyspareunia. atrophic vaginitis and pain.

Skin telangectasia

Vaginal dilators

Sparing normal tissues is not an easy task

Intensity modulated radiotherapy (IMRT)

Using multiple fields allows for better sparing of normal tissues

Summary

• Radiotherapy is effective in treating pelvic cancers.• Acute radiotherapy side effects recover shortly after

therapy ends.• Late effects tends be permanent and can take months

to years to manifest.• New radiotherapy techniques allows for better tumour

control with good sparing of normal tissues.