Gynecologic Radiation Therapy
with Francis Grumbine, MD
What are the two ways to deliver radiation for GYN cancers?
According to the American Cancer Society, nearly 85,000 cases of gynecologic (GYN) cancers are diagnosed in the United States each year. GYN cancer is defined as any cancer of the cervix, fallopian tubes, ovaries, uterus, vagina or vulva.
Like other parts of the body, the reproductive organs are comprised of many types of cells. When these cells divide and spread in an abnormal, uncontrolled manner, they form tumors. According to Francis Grumbine, MD, Chairman of the Department of Gynecology and Division Head of Gynecologic Oncology at GBMC, there are several ways to treat malignant (cancerous) tumors.
Cancer treatment depends on several factors including the type, stage and location of the tumor. “Prior to deciding on treatment, we use diagnostic tools to see if the cancer has spread to the lymph nodes or other organs,” says Dr. Grumbine. Diagnostic tools may include MRI, CT, PET and ultrasound scans of the abdomen and pelvis to see areas that cannot be viewed directly.
Common treatment options include surgery, radiation therapy, chemotherapy or a combination. At GBMC, patients talk with several cancer specialists before deciding on the best treatment. “We take a multidisciplinary approach to treating gynecologic cancers. The GYN oncologist makes the initial diagnosis and then begins to orchestrate care,” says Dr. Grumbine. Other members of the care team include the medical oncologist, who prescribes chemotherapy and possibly biologicals, and the radiation oncologist.
Radiation therapy damages the cancer cells’ ability to multiply, eventually causing them to die and be removed from the body. Although the surrounding healthy tissues may also be damaged by radiation, those cells have the ability to repair themselves.
Radiation therapy has three main goals, depending on the patient’s needs. It can be used to cure cancer, prevent recurrence or relieve pain and other symptoms (known as palliative care). Radiation therapy is often used in combination with other treatment methods. For example, even though ovarian cancer is usually treated with chemotherapy, radiation therapy can still play a role. “Radiation therapy can be used for palliation of late stage ovarian cancer or to treat a local recurrence,” says Dr. Grumbine.
Radiation therapy, either alone or in combination with other methods, is often used to treat cervical cancer. “Early stage cervical cancer is commonly treated with either radiation therapy or radical surgery. In advanced stages, we use a combination of radiation therapy plus chemotherapy,” says Dr. Grumbine. Radiation therapy plus chemotherapy has been proven to provide better cure rates. It is an effective combination in part because chemotherapy helps sensitize the tumor to the effects of radiation.
Thanks to emerging technology, radiation therapy is used to treat even more types of GYN cancers. “In the past, radiation therapy was not very useful for treating cancer of the vulva or other types of vaginal cancers. But with today’s equipment, radiation therapy is very much a part of these treatment plans,” says Dr. Grumbine. Imagine-guided radiation therapy allows doctors to deliver a high dose of radiation directly to the tumors, while sparing more of the surrounding normal tissue.
Radiation therapy can be administered a couple of ways. External beam radiation therapy is similar to getting an x-ray. Radiation is delivered in a “beam” to a precise location. It involves a series of daily outpatient treatments for five to six weeks. Each session takes about a half an hour or less.
Radiation may also be delivered locally in a treatment known as brachytherapy. This method involves placing radioactive sources in or next to the cancer. With a lower dose rate, it may be delivered over the course of 48 to 72 hours in an inpatient procedure. With a high dose after loading systems, the radiation dose is given for a short time as an outpatient. Usually, brachytherapy is used in conjunction with external beam radiation.
Doctors at GBMC work to determine the best course of treatment for each individual patient. Those who are still of childbearing age may work with a fertility specialist in addition to the rest of the cancer team.
According to Dr. Grumbine, early detection is one of the most effective tools against GYN cancers, especially cervical cancer. He advises women to have routine Pap tests and to share with their doctor any concerns or symptoms that are present. For younger women and girls, it is now possible to prevent infection with the human papillomavirus (HPV) and thereby prevent the development of cervical dysplasia, cervical cancer and genital warts. Dr. Grumbine urges women to discuss the new HPV vaccine with their doctor or pediatrician.
