Radiotherapy for Cervical Cancer: Types, Success Rate, Side Effects And More

Radiotherapy for cervical cancer is a vital treatment approach that utilizes high-energy rays to eliminate cancerous cells. This often involves a combination of external radiation, delivered from a machine outside the body, and internal radiation, where a radioactive source is placed close to the tumor. To enhance the effectiveness of the treatment, chemotherapy is frequently administered concurrently. In certain cases, radiotherapy for cervical cancer may serve as the primary treatment method, taking the place of surgery.

What is Radiotherapy for Cervical Cancer?

The number of radiotherapy sessions for cervical cancer varies. External beam radiotherapy (EBRT) typically involves daily sessions, five days a week, for about five to six weeks (around 25 to 30 sessions). Brachytherapy, or internal radiation, varies. Low-dose-rate (LDR) involves days of continuous low-dose radiation, often in a hospital. High-dose-rate (HDR), the more common type, involves a few shorter sessions with higher doses, sometimes as an outpatient.

Radiotherapy for cervical cancer uses high-energy rays to kill or stop cancer cell growth. It damages the DNA in cancer cells, disrupting their function and multiplication. External beam radiotherapy (EBRT) aims high-energy rays at the cancer from outside the body. It’s like a strong x-ray focused on the tumor. Brachytherapy, or internal radiation, places radioactive material inside the patient, in or near the cancer.

Types of Radiation Therapy for Cervical Cancer

There are two main types of radiotherapy for cervical cancer. External beam radiation therapy (EBRT) involves directing high-energy x-rays at the cancerous area from a machine outside the body. This is often done daily over several weeks.

The other type is internal radiation therapy, or brachytherapy. This involves placing a radioactive source inside or very close to the tumor, allowing a high dose of radiation to be delivered to a specific area. Brachytherapy can be given at a low dose rate over a few days or at a high dose rate in several shorter sessions.

The choice between these types of radiation therapy for cervical cancer, and whether they are used alone or in combination, often depends on the stage of the cancer. For instance, brachytherapy is strongly recommended for all women receiving definitive radiation therapy for cervical cancer. In some cases, EBRT and brachytherapy are used together as part of the primary treatment.

External Beam Radiotherapy (EBRT) for Cervical Cancer

External beam radiotherapy (EBRT) for cervical cancer delivers high-energy x-rays to the tumor from an external machine. Each session is brief, but setup takes a bit longer. Commonly used as a main treatment, EBRT is often combined with chemotherapy to improve effectiveness. A typical course involves daily treatments, five days a week, for around five weeks. Before treatment begins, doctors use scans to carefully plan the radiation delivery, ensuring the cancer receives a high dose while nearby healthy tissues are spared as much as possible.

Internal Radiation for Cervical Cancer (Brachytherapy)

Internal radiotherapy for cervical cancer, known as brachytherapy, delivers a high dose of radiation directly to the tumor by placing a radioactive source inside or close to it. This method is often used in combination with external beam radiation therapy as a primary treatment. There are two main types: high-dose-rate (HDR) brachytherapy, which involves several short, outpatient treatments where the radiation source is temporarily inserted, and low-dose-rate (LDR) brachytherapy, which requires a hospital stay for a few days while the radioactive material remains in place.

How Effective is Radiotherapy for Cervical Cancer?

Wang et al. (2023, International Journal of Environmental Research) found that intensity-modulated radiotherapy (IMRT) for bulky cervical cancer (≥4 cm) had acceptable safety and efficacy. With a median follow-up of 6.84 years, the 5-year OS and DFS were 66.33% and 75.12%, respectively, with a 7.14% local recurrence rate.

Kim et al. (2018, Gynecologic Oncology) found salvage radiotherapy (RT) for cervical cancer , including IMRT, to be safe and effective for recurrent disease. The 5-year OS rate was 66%, with 5-year LFFS and PFS rates of 63.9% and 39.6%, respectively.

Van Den Akker et al. (2020, International Journal of Gynecological Cancer) found that postoperative (chemo)radiation for early-stage cervical cancer provides adequate pelvic tumor control, but overall survival is limited by distant metastasis. Five-year overall survival was 63.9%.

How Many Radiotherapy Sessions for Cervical Cancer?

The number of radiotherapy sessions for cervical cancer varies. External beam radiotherapy (EBRT) typically involves daily sessions, five days a week, for about five to six weeks (around 25 to 30 sessions). Brachytherapy, or internal radiation, varies. Low-dose-rate (LDR) involves days of continuous low-dose radiation, often in a hospital. High-dose-rate (HDR), the more common type, involves a few shorter sessions with higher doses, sometimes as an outpatient.

source: www.georgiaradiationtherapy.com

What are the Side Effects of Radiation Therapy for Cervical Cancer?

Radiotherapy for cervical cancer can cause a range of side effects. These effects vary depending on the individual and the specific treatment. Common short-term side effects include fatigue, nausea, diarrhea, and skin changes in the treated area, resembling a sunburn. Patients might also experience bladder irritation, vaginal pain or discharge, and menstrual changes. Longer-term side effects can include vaginal dryness or narrowing, which may cause discomfort during sex. Some patients may also experience bowel or bladder problems, and in some cases, infertility.

Maduro et al. (2003, Cancer Treatment Reviews) reviewed the acute and long-term toxicity of radiotherapy with or without chemotherapy for cervical cancer. Acute toxicity is common, with 61% of patients experiencing rectosigmoid effects. Late effects can develop for at least 20 years post-treatment.

Short-Term Side Effects

Short-term side effects of radiotherapy for cervical cancer can include fatigue, which necessitates adequate rest while trying to remain active. Skin irritation in the treatment area, similar to a sunburn, may occur and should be managed with prescribed moisturizers. Vaginal discomfort, such as increased sensitivity or soreness, and possible discharge are also common. Nausea and potential diarrhea can be managed with anti-sickness medications and dietary adjustments like avoiding fatty or strong-smelling foods. Bladder issues, such as frequent urination or stinging, can arise, and staying well-hydrated is important. Radiographers can provide specific advice on managing these temporary side effects.

Long-Term Side Effects

Long-term side effects of radiotherapy for cervical cancer can include lasting bowel and bladder dysfunction. These issues may involve changes in bowel habits, such as increased frequency or urgency, and bladder problems like increased urination or incontinence. Sexual health can also be affected, potentially leading to decreased desire or changes in sensation. Vaginal stenosis, a narrowing and drying of the vagina, is another potential long-term effect, which can cause discomfort or pain during sexual activity. Additionally, radiotherapy can impact fertility, potentially causing infertility by affecting ovarian function.

George et al. (2009, Radiotherapy and Oncology) found that rectosigmoidoscopy is sensitive in detecting mucosal changes after radiotherapy for cervical cancer, correlating with high-dose volumes and clinical symptoms. The development of mucosal and clinical changes in the rectum follows a clear dose–effect and volume–effect.

Bleeding After Radiotherapy for Cervical Cancer

After radiotherapy for cervical cancer, vaginal bleeding can occur for a few reasons. It’s often related to the removal of applicators used in internal radiotherapy (brachytherapy). In such cases, the bleeding is usually light and resolves within a couple of days. The tissues in the vagina can also become irritated or damaged during the radiation treatment itself, which may cause some bleeding.

However, any heavy or prolonged bleeding should be promptly reported to your radiotherapy doctor or nurse. They can assess the cause of the bleeding and recommend appropriate treatment or management strategies.

How Long Does It Take to See Results?

Radiation therapy for cervical cancer doesn’t eliminate cancer cells immediately. Instead, it damages their DNA, and it may take days or weeks of treatment before the cells start to die. Following the completion of radiotherapy, cancer cells can continue to die off for several weeks or months. Several factors can influence how quickly tumors respond to radiotherapy. These include the tumor’s size, stage, and specific characteristics. Individual patient factors also play a role. Doctors use follow-up imaging, such as scans, to monitor how the tumor is responding and to assess the effectiveness of the treatment.

What Are the Costs of Radiotherapy for Cervical Cancer?

The cost of radiotherapy for cervical cancer can vary significantly. Key factors influencing the overall expense include the duration and specific type of treatment, such as external beam radiation or brachytherapy. The extent of the disease and the complexity of the treatment plan also play a role.

Health insurance coverage can greatly affect a patient’s out-of-pocket expenses. Most insurance plans cover at least a portion of cancer treatment costs, but the level of coverage varies. Patients should check with their insurance provider to understand their specific benefits and potential costs, such as copays, deductibles, and coinsurance.

For those facing financial challenges, several financial assistance options are available. Many hospitals and cancer centers offer financial counseling and assistance programs to help patients manage treatment costs. Additionally, various non-profit organizations and government programs provide financial support to cancer patients, including help with medication costs, transportation, and other related expenses.

Bauer-Nilsen et al. (2018, International Journal of Radiation Oncology Biology Physics) used time-driven activity-based costing to analyze the cost of radiation therapy for cervical cancer. Brachytherapy accounted for most costs ($8610.68, 66.9% of total), with personnel representing 49.8% of total costs. The study found that current reimbursement policies do not reflect the increased physician effort and delivery costs of brachytherapy.

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Can Radiotherapy Be Combined with Other Treatments for Cervical Cancer?

Radiotherapy is frequently combined with other treatments for cervical cancer. For instance, it’s commonly used alongside chemotherapy, a combination known as chemoradiation.

However, this combined approach, and radiotherapy alone, can sometimes lead to chronic side effects. These may include bone health issues, such as an increased risk of fractures, and potential damage to organs in the treated area. Hormone imbalances can also occur, particularly if the ovaries are affected, potentially leading to early menopause.

Several strategies can help prevent or manage these potential long-term effects. These include careful treatment planning to minimize radiation exposure to healthy tissues, the use of specialized radiation techniques, and close monitoring for any signs of complications. Additionally, medications and lifestyle changes may be recommended to help maintain bone health and manage hormone imbalances.

A 2010 Cochrane Library review found that chemoradiotherapy improves 5-year survival by 6% compared to radiotherapy alone in cervical cancer. Chemoradiotherapy also reduced local and distant recurrence and improved disease-free survival. Acute hematological and gastrointestinal toxicity were increased with chemoradiotherapy.

Sex After Brachytherapy for Cervical Cancer

After brachytherapy for cervical cancer, women may experience several concerns that affect their sexual health. Common issues include vaginal dryness, which can cause discomfort, and vaginal stenosis, a narrowing of the vagina that may lead to painful intercourse. Some women may also experience pain during sex and changes in libido or sexual desire.

Several strategies can help women resume a healthy sex life after brachytherapy. Using vaginal dilators as recommended by healthcare providers can help prevent or alleviate vaginal stenosis. Water-based lubricants can effectively manage vaginal dryness and reduce discomfort during sexual activity. Open communication with partners is crucial, and exploring different sexual positions may also help. If issues persist, seeking advice from a healthcare professional or a sex therapist can provide additional support and solutions.

Chuk et al. (2024, Gynecologic Oncology) found that cervical cancer patients self-report high rates of sexual distress, dysfunction, and menopause symptoms. There was discordance between oncologist-assessed vaginal toxicity and patient-reported outcomes.

What Research is Being Done on Radiotherapy for Cervical Cancer?

Aoshika et al. (Brachytherapy, 2022) found that CT-based adaptive brachytherapy with external beam radiotherapy, with or without chemotherapy, produced favorable local control with low late toxicity in small to medium-sized cervical tumors. Local control was less favorable in large T3 tumors.

How Can Patients Support Their Health During Radiotherapy?

Patients can take several steps to support their health during radiotherapy. Maintaining good nutrition is crucial, and while specific dietary recommendations can vary, a balanced diet is generally advised.

Physical activity, as tolerated, can help manage fatigue and improve overall well-being. It’s important to balance activity with rest and avoid overexertion. Mental well-being is also essential. Patients should seek support from family, friends, or support groups, and consider stress-reduction techniques like meditation or deep breathing exercises.

What Are the Risks of Radiation for Cervical Cancer?

Radiotherapy for cervical cancer, while effective, carries potential risks. Long-term health issues can arise, including the possibility of developing secondary cancers in the treated area.

Infertility is another significant concern, as radiation can damage the ovaries. Other potential long-term effects include bone health issues and damage to organs in the treated area.

To mitigate these risks, healthcare providers employ several strategies. Careful treatment planning aims to minimize radiation exposure to healthy tissues. Advanced radiation techniques and precise delivery methods can also help reduce the likelihood of complications. Regular follow-up and monitoring are essential for early detection and management of any long-term effects.

Written By Aren Karapetyan, MD