Radiation Therapy for Endometrial Cancer - An Insight

What Is Radiation Therapy for Endometrial Cancer?

Radiation is most commonly used after surgery for the treatment of uterine cancer. Radiation therapy destroys cancer cells that may still be present in the area that has already been treated. If you are going to have radiation as a follow-up treatment for surgery, you will be given time to recover before you begin radiation treatment. This is often 4 to 6 weeks. Sometimes, radiation therapy is used before surgery to make a tumor smaller so that it can be removed more easily. People who are not healthy enough to undergo surgery will have radiation therapy.

When Is Radiation Therapy Used for Endometrial Cancer?

Once the uterus and cervix are removed, the upper vagina is sometimes treated with brachytherapy. This type of brachytherapy is called vaginal brachytherapy. A radioactive material is placed in a cylinder, called an applicator, and this cylinder is inserted into the vagina. (It feels very similar to a tampon). The size of the cylinder and the amount of radiation in the cylinder might vary. With this type of therapy, the vagina absorbs most of the radiation. Other areas, such as the bladder and rectum, receive less radiation exposure. This is done in a hospital's radiation therapy department or at a facility specializing in radiation therapy. Two types of brachytherapy are used to treat endometrial cancer:

• Low-dose rate (LDR).

• High-dose rate (HDR).

What Are the Types of Radiation Therapy for Endometrial Cancer?

1. External Beam Radiation Therapy (EBRT):

The radiation used in this kind of treatment comes from an external source. For four to six weeks, external beam radiation therapy for endometrial cancer is mostly administered five days a week. Tiny tattoos or ink are used to carefully mark the skin covering the treatment region. To ensure that you are in precisely the same posture for every treatment, a custom-made pelvic and lower back mold is used. Daily trips to the radiation center are typically required, but each treatment takes less than thirty minutes. Chemotherapy is sometimes administered in conjunction with radiation to enhance its effectiveness.

• Adaptive Radiation Therapy

It evaluates the tumor's condition, size, shape, and location as well as the surrounding organs on a daily basis using cutting-edge equipment and artificial intelligence software. This minimizes adverse effects by enabling our staff to modify and customize your treatment in real time.

• 3D Conformal Radiation Therapy

Cancer is often treated using 3D conformal radiotherapy. Powerful energy beams are involved in radiation therapy to destroy cancer cells. Protons, X-rays, and other sources can provide the energy. The beams used in 3D conformal radiotherapy are precisely tailored to the shape of the malignancy. 3D conformal radiation can be utilized not just to cure cancer but also to treat some non-cancerous tumors and diseases. Anywhere throughout the body, it can be applied.

• Intensity Modulated Radiation Therapy (IMRT)

Radiation is divided into "minibeams," or several tiny, computer-controlled dosages of varying intensities, in intensity-modulated radiation therapy for uterine cancer. The doctor can adjust the radiation dose to the tumor's size, shape, and location using intensity-modulated radiation treatment. Additionally, this method shields healthy tissue in the bladder and intestines from radiation damage. For several weeks, intensity-modulated radiation therapy is administered once daily, 5 days a week.

• Volumetric Modulated Arc Therapy (VMAT)

During each treatment, this kind of therapy enables the linear accelerator to rotate 360 degrees around you one or more times. This means that doctors can target the tumor while avoiding healthy tissue because radiation can be administered from practically any angle. Additionally, doctors can adjust the intensity and angle of the radiation beams without halting treatment. Treatment sessions may be shorter than with other forms of external beam radiation therapy since this radiation therapy is administered continuously. Over several weeks, sessions are offered once a day, five days a week.

• Stereotactic Body Radiation Therapy (SBRT)

A few strong doses of precisely focused radiation beams are administered during stereotactic body radiation treatment. For a few weeks, this has happened almost every day. If you are too sick or too elderly to have surgery, your doctor may use this method to treat tiny endometrial tumors. If various forms of external beam therapy fail to eradicate the malignancy, our experts may additionally suggest stereotactic body radiation therapy. This method, like previous radiation treatments, accurately targets the tumor while avoiding healthy tissue by using computer and imaging guidance.

• Adaptive Radiation Therapy

Adaptive radiotherapy is a type of radiation therapy in which the treatment is continually adjusted to account for changes in the patient's body, delivering the most accurate radiation dosage possible. Radiation therapy can take several days or even weeks to complete, and various changes can occur in the patient's body during that time due to the treatment or other factors. These changes can include tumor size, shape, or position, changes in other organs, or weight loss. Even minor changes can require adjustments to radiation dosage.

2. Brachytherapy (Internal Radiation)

Brachytherapy involves the use of sealed radioactive sources that are placed inside tumors (interstitial) or in body cavities (intracavitary). This source is an injection into the prostate gland, which will deliver the required dose for the entire time it is in the body. However, in most cases, a radioactive source is inserted into the body and removed after the time calculated to deliver a specified radiation dose has elapsed. This time period must be determined by an oncologist.

• High-Dose Rate (HDR) Brachytherapy

High-dose-rate brachytherapy for endometrial cancer, which can be performed using miniaturized sources, delivers a dose rate of more than 12 gray per hour, given short treatment times. Because of this, HDR brachytherapy can also be done on an outpatient basis. Brachytherapy is an important part of radiation therapy for gynecologic malignancies. Other indications for brachytherapy include prostate, breast, soft tissue sarcomas (cancer that originates from connective tissue), certain head and neck malignancies, and skin cancers.

• Low-Dose Rate (LDR) Brachytherapy

In the low-dose-rate (LDR) brachytherapy method, the applicator is placed in the cavity or inside the tumor, and the source is fed into the applicator while the patient is in a shielded room. They are kept in isolation until the source is removed (which may take 12 to 24 hours).

• Vaginal Brachytherapy

Intravaginal brachytherapy involves the doctor inserting an applicator into the vagina. The applicator contains radioactive material that is placed in the vaginal cuff and then withdrawn after a period of 10 minutes. This technique reduces the risk of radiation exposure to adjacent organs, such as the bladder and rectum. Intravaginal brachytherapy is administered weekly for 3 weeks. Our physicians can administer a local anesthetic to make you more comfortable during the procedure.

• Interstitial Brachytherapy

In interstitial brachytherapy, the doctor will place the radiation directly into or near the tumor. This type of treatment can be used when the cancer has spread to an area in the pelvis that cannot be treated using the intravaginal method. In the process of interstitial brachytherapy, the doctor will use a type of anesthesia that will numb the area below the waist. It can also be done under general anesthesia. The doctors will use this type of treatment for several minutes at a time over a few days or weeks.

Chemoradiation (Radiation + Chemotherapy Combined)

Chemotherapy and radiation therapy are two potentially effective cancer treatments that are combined in chemoradiation. For certain malignancies like endometrial cancer, chemoradiation is not a viable treatment. It can be challenging to endure two intense cancer treatments at once. However, in certain circumstances, chemoradiation can have major advantages. Chemoradiation may be able to halt the growth of tumors in some patients with specific forms of cancer. It might improve survival chances and, in certain cases, even be curative. Treatment options for chemoradiation include lung disease and cervical carcinoma.

How Is Radiation Therapy Planned for Endometrial Cancer?

The radiation treatment for endometrial cancer is planned in a way that the cancer cells receive the required amount of radiation, while other healthy tissues, such as the bladder and bowel, remain protected. This is a precise procedure that may involve a series of steps before the actual treatment is initiated.

CT Scan and 3D Imaging

A planning CT scan (computed tomography) is conducted, which helps create a precise map of the internal organs in the pelvic area. During the procedure, the patient is placed in a specific position, as they will be during the actual treatment. This helps create a three-dimensional image of the internal organs, making it easy for the doctor to locate the target area.

Custom Treatment Mapping

The CT scan images are then used by radiation treatment experts to create a specialized map for the patient. This includes determining the amount of radiation and the specific direction from which it will be emitted. Advanced technology is also available, which helps shape the radiation beams depending on the size of the cancer cells.

How Long Does Radiation Treatment Take?

The entire treatment schedule may vary depending on the stage and type of treatment. External beam radiation therapy is usually administered five days a week, while internal radiation therapy, also known as brachytherapy, may require fewer visits. Each radiation treatment can take only a few minutes, though preparation can take a bit longer.

What Are the Side Effects of Radiation Therapy for Endometrial Cancer?

Short-Term Side Effects

Side effects are more common in external beam radiation than with brachytherapy.

• Severe fatigue, which may not begin until about 2 weeks after treatment is started.

• Diarrhea is common, but it can usually be managed with over-the-counter medications.

• Nausea and vomiting can occur, but these can be treated with medication.

Side effects of chemotherapy and radiation tend to increase if chemotherapy is used with radiation.

• Changes in the skin, such as mild redness, peeling, or blistering, are common. The skin may be more susceptible to infection, so care is needed to clean and protect the area that is exposed to the radiation. As the area heals, the skin may become darker or less flexible (harder) in the area treated with radiation.

• Irritation of the bladder, called radiation cystitis, can cause discomfort while urinating, problems urinating, blood in the urine, and a frequent urge to urinate.

• Irritation in the intestine.

• When there is irritation or bleeding in the rectum, it is called radiation proctitis. In this case, the doctor may recommend a special enema. Vaginal irritation with discomfort and discharge. This is referred to as radiation vaginitis. In cases of severe irritation, open sores may develop in the vagina and may need to be treated with creams.

• Low blood counts, anemia, and leukopenia (low WBC). The blood counts return to normal within a few weeks of stopping the radiation.

Long-Term Side Effects

• Vaginal Dryness: Vaginal dryness is experienced after vaginal brachytherapy compared to pelvic radiation therapy. Tissue may also form in the vagina.

• Premature Menopause: Pelvic radiation therapy may damage the ovaries and lead to premature menopause.

• Lymphedema: Pelvic radiation therapy may also lead to blockages in the leg, preventing fluids from leaving the leg. This may lead to severe leg swelling, known as lymphedema.

• Weakened Bones: Pelvic radiation may lead to weakened bones that may fracture the hips or pelvic bones.

• Bladder and Bowel Problems: Pelvic radiation may also lead to long-term problems in the bladder or bowel, referred to as radiation cystitis or proctitis.

Can Radiation Therapy Cure Endometrial Cancer?

The patient with endometrial cancer needs to know the importance of radiation therapy in managing the disease. The extent to which the disease can be cured using the therapy depends on several factors, including the stage of the cancer, the extent of the spread of the cancer, and the health status of the patient. For patients with endometrial cancer, the therapy can be used as the main form of management in cases where the patient is unable to undergo surgery because of health conditions in the body. It is important to know that the role of therapy in the management of the disease, whether curative or palliative, depends on the patient's condition.

How Effective Is Radiation Therapy for Endometrial Cancer?

Radiation therapy is considered to be a reliable option in the management of endometrial cancer, especially if done in the appropriate setting. Its efficacy depends greatly on how early the disease is diagnosed and whether it is treated alone or in combination with other treatments. In the early stages of endometrial cancer, radiation therapy is sometimes used following surgery to eliminate any possible lingering cancer cells. In such instances, there is a significant reduction in the chances of relapse, and sometimes even a cure is possible.

When endometrial cancer is diagnosed in later stages, radiation therapy is not used alone to treat the disease but rather in combination with other treatments such as surgery, chemotherapy, or both. In such situations, the purpose of using radiation therapy is to manage the growth of the tumor, minimize the symptoms, and improve the quality of life.

Not all individuals have the same outcome, even though radiation therapy is highly effective. Its use, whether curative or supportive, is determined by the particular condition of the disease, which is decided by a well-planned strategy.

Conclusion

Radiation therapy still plays a significant role in managing endometrial cancer, especially in controlling the recurrence of the disease and managing symptoms when necessary. Radiation therapy may be used after surgery to control any remaining cancer cells or may be used as a main treatment option when surgery is not applicable. Nowadays, it is possible to use radiation therapy in a targeted manner with a high degree of precision and minimize the impact on healthy tissues around the targeted area. The benefits that radiation therapy provides in managing endometrial cancer depend on various factors, such as the stage and progression of the disease and the patient’s general well-being. To get personalized advice, you can consult a cancer specialist.

Key Takeaways

• Radiation therapy assists in reducing the chances of recurrence of endometrial cancer.

• It may be used as a main treatment option if surgery cannot be performed.

• This therapy allows for accurate targeting and minimizes damage to healthy tissues.

• It may be combined with other methods, including chemotherapy, to control the disease.

• This form of therapy helps in the control of the symptoms in the advanced stages of endometrial cancer.

• The success of radiation therapy depends on the stage of the disease and the patient's general condition.