Radiotherapy in Gynecological Cancers
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Review
P: 190-196
November 2022

Radiotherapy in Gynecological Cancers

Nucl Med Semin 2022;8(3):190-196
1. İstanbul Üniversitesi, İstanbul Tıp Fakültesi Onkoloji Enstitüsü, Klinik Onkoloji Anabilim Dalı, Radyasyon Onkolojisi Bilim Dalı, İstanbul, Türkiye
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ABSTRACT

Radiotherapy (RT) is a type of cancer treatment that uses beams of intense energy to kill cancer cells. External RT is a type of radiation therapy that uses a machine to aim high energy X-rays at the cancer from outside of the body. Brachytherapy (BrT) is the method of treatment performed by passing a radioactive source through an applicator, tube or needle placed in or near of the tissue or in the body cavities to be treated. External RT and BrT are important treatment modalities in the treatment of gynecological tumors. For patients with gynecologic malignencies, RT is often an integral component of multi-modality management and can be delivered in the preoperative, definitive, adjuvant, and palliative setting. Adjuvant RT is used in endometrial, cervical, vaginal and vulvar cancers. Medically inoperabl endometrial cancer, cervical and vulvar cancers are mostly treated with definitive RT. On the other hand, palliative RT can be applied for symptom palliation in all patients with gynecological malignancies that cause bleeding, vascular structure or nerve tissue compression and can not tolerate more radical treatment options with their current condition. Imaging techniques may be used to assist in diagnosis, staging, and follow-up of oncology patients. Magnetic rezonans imaging and positron emission tomography (PET) play central and complementary roles in the care of patients with gynecologic cancer. While magnetic resonance imaging is frequently used to evaluate the local stage in determining the treatment of gynecological tumors, positron emission tomography (PET) is preferred to evaluate the systemic status. It is important in the process management to evaluate the treatment of gynecological tumors by evaluating the examination findings, imaging and pathological data in multidisciplinary tumor boards. PET/CT is an indispensable imaging method in RT applications for evaluation of lymph node metastases, distant metastasis scanning and localization of the primary tumor.

References

1
Bradley KA, Petereit DG. Radiation Therapy for Gynecologic Malignancies. Hematology/Oncology Clinics of North America. 2006.
2
Chopra S, Gupta S, Kannan S, et al. Late Toxicity After Adjuvant Conventional Radiation Versus Image-Guided Intensity-Modulated Radiotherapy for Cervical Cancer (PARCER): A Randomized Controlled Trial. J Clin Oncol 2021;39:3682-3692.
3
Elledge CR, Beriwal S, Chargari C, et al. Radiation therapy for gynecologic malignancies during the COVID-19 pandemic: International expert consensus recommendations. Gynecol Oncol 2020;158:244-253.
4
Rizzo S, Calareso G, De Maria F, et al. Gynecologic tumors: how to communicate imaging results to the surgeon. Cancer Imaging 2013;13:611-625.
5
Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021;71:209-249.
6
NCCN Guidelines - Cervical Cancer Version 1.2022 [Internet]. Available from: www.nccn.org/professionals/physician_gls/pdf/cervical_blocks.pdf
7
Xiao S, Fan J, He S, Yu K, Deng X, Xue M. Analysis of human papillomavirus infection in 16 320 patients from gynecologic clinic. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2015;40:373-379.
8
Merz J, Bossart M, Bamberg F, Eisenblaetter M. Revised FIGO Staging for Cervical Cancer - A New Role for MRI. Rofo 2020;192:937-944.
9
Tsikouras P, Zervoudis S, Manav B, et al. Cervical cancer: screening, diagnosis and staging. J BUON 2016;21:320-325.
10
Sironi S, Buda A, Picchio M, et al. Lymph node metastasis in patients with clinical early-stage cervical cancer: detection with integrated FDG PET/CT. Radiology 2006;238:272-279.
11
Choi HJ, Ju W, Myung SK, Kim Y. Diagnostic performance of computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with cervical cancer: meta-analysis. Cancer Sci 2010;101:1471-1479.
12
Adam JA, van Diepen PR, Mom CH, Stoker J, van Eck-Smit BLF, Bipat S. [18F]FDG-PET or PET/CT in the evaluation of pelvic and para-aortic lymph nodes in patients with locally advanced cervical cancer: A systematic review of the literature. Gynecol Oncol 2020;159:588-596.
13
Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol 1999;73:177-183.
14
Peters WA, Liu PY, Barrett RJ, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 2000;18:1606-1613.
15
Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol 2008;26:5802-5812.
16
Abu-Rustum NR, Yashar CM, Bean S, et al. NCCN Guidelines Insights: Cervical Cancer, Version 1.2020. J Natl Compr Canc Netw 2020;18:660-666.
17
Mangaj A, Chopra S, Nout R. Defining the role of high-dose radiation in oligometastatic & oligorecurrent cervical cancer. Indian J Med Res 2021;154:303-318.
18
Tsai CC, Tsai CS, Ng KK, et al. The impact of image fusion in resolving discrepant findings between FDG-PET and MRI/CT in patients with gynaecological cancers. Eur J Nucl Med Mol Imaging 2003;30:1674-1683.
19
Sanei Sistani S, Parooie F, Salarzaei M. Diagnostic Accuracy of 18F-FDG-PET/CT and MRI in Predicting the Tumor Response in Locally Advanced Cervical Carcinoma Treated by Chemoradiotherapy: A Meta-Analysis. Contrast Media Mol Imaging 2021;2021:8874990.
20
Cancer Genome Atlas Research Network, Kandoth C, Schultz N, et al. Integrated genomic characterization of endometrial carcinoma. Nature 2013;497:67-73. Erratum in: Nature 2013;500:242.
21
Höhn AK, Brambs CE, Hiller GGR, May D, Schmoeckel E, Horn LC. 2020 WHO Classification of Female Genital Tumors. Geburtshilfe Frauenheilkd 2021;81:1145-1153.
22
Gee MS, Atri M, Bandos AI, Mannel RS, Gold MA, Lee SI. Identification of Distant Metastatic Disease in Uterine Cervical and Endometrial Cancers with FDG PET/CT: Analysis from the ACRIN 6671/GOG 0233 Multicenter Trial. Radiology 2018;287:176-184.
23
Bollineni VR, Ytre-Hauge S, Bollineni-Balabay O, Salvesen HB, Haldorsen IS. High Diagnostic Value of 18F-FDG PET/CT in Endometrial Cancer: Systematic Review and Meta-Analysis of the Literature. J Nucl Med 2016;57:879-885.
24
Concin N, Matias-Guiu X, Vergote I, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer 2021;31:12-39.
25
NCCN Guidelines – Uterine Neoplasms 1.2022 [Internet]. Available from: www.nccn.org/professionals/physician_gls/pdf/uterine.pdf
26
Fuh KC, Berek JS. Current management of vulvar cancer. Hematol Oncol Clin North Am 2012;26:45-62.
27
Stehman FB, Look KY. Carcinoma of the vulva. Obstet Gynecol 2006;107:719-733.
28
Kataoka MY, Sala E, Baldwin P, et al. The accuracy of magnetic resonance imaging in staging of vulvar cancer: a retrospective multi-centre study. Gynecol Oncol 2010;117:82-87.
29
Olawaiye AB, Cotler J, Cuello MA, et al. FIGO staging for carcinoma of the vulva: 2021 revision. Int J Gynaecol Obstet 2021;155:43-47.
30
NCCN Guidelines – Vulvar Cancer 2.2022 [Internet]. Available from: www.nccn.org/professionals/physician_gls/pdf/vulvar.pdf
31
Cohn DE, Dehdashti F, Gibb RK, et al. Prospective evaluation of positron emission tomography for the detection of groin node metastases from vulvar cancer. Gynecol Oncol 2002;85:179-184.
32
Kamran MW, O'Toole F, Meghen K, Wahab AN, Saadeh FA, Gleeson N. Whole-body [18F]fluoro-2-deoxyglucose positron emission tomography scan as combined PET-CT staging prior to planned radical vulvectomy and inguinofemoral lymphadenectomy for squamous vulvar cancer: a correlation with groin node metastasis. Eur J Gynaecol Oncol 2014;35:230-235.
33
Gadducci A, Fabrini MG, Lanfredini N, Sergiampietri C. Squamous cell carcinoma of the vagina: natural history, treatment modalities and prognostic factors. Crit Rev Oncol Hematol 2015;93:211-224.
34
Adams TS, Cuello MA. Cancer of the vagina. Int J Gynaecol Obstet 2018;143 Suppl 2:14-21.