Author:
Kelly Underhill, MD
Department of Radiation Oncology
Bodine Center for Cancer Treatment
Thomas Jefferson University Hospital
It is estimated that
16,000 new cases of cervix cancer will be diagnosed this year in the
United States. While
the total number of new cases is much lower now than it was 20 years ago,
close to one third of these women may be expected to die from their
disease.
The treatment of cervix
cancer is stage and age dependent. Cancers
that are very small and confined to the cervix are usually treated with a
radical hysterectomy, an operation that removes the entire uterus,
including the cervix and its tumor, the fallopian tubes and ovaries, and
many of the pelvic lymph nodes. Another
equally effective form of treatment is pelvic radiotherapy.
This is the choice of treatment for older women who might not
tolerate radical surgery, and for those women with more advanced stages of
disease.
Recently, a number of
cooperative group trials in the United States have shown that the addition
of systemic chemotherapy to pelvic radiotherapy results in a markedly
improved tumor response, and an improvement in overall survival, in women
with advanced stages of disease. This
has now become the standard of care at Jefferson.
Research efforts continue to evaluate the most effective type of
chemotherapy and the manner in which it ought to be combined with
radiotherapy, and Jefferson oncologists are active participants in these
trials.
Another new advance at
Jefferson has been the addition of High Dose Rate Brachytherapy to the
treatment of cervix cancer. Brachytherapy
has long been an intregral component of the radiotherapeutic management of
cervix cancer. Brachytherapy,
literally translated, means “radiotherapy at short distance.”
In the context of cervix cancer, it refers to the placement of
radioactive sources in and around the cervix tumor.
Traditionally, patients are admitted to hospital for this
treatment, where they are taken to the operating room for placement of an
intrauterine applicator, and then confined to bed for the next 4 or 5 days
while the radioactive material inside the applicator does its work.
While this is a most effective way of destroying cancer cells, the
treatment is not without its risks. Prolonged
bed rest is associated with the risk of pneumonia and blood clots, and the
applicator can become quite uncomfortable after 4 days of uninterrupted
treatment.
 In
response to these and other concerns, radiotherapy researchers have tried
to modify the manner in which the brachytherapy is given.
One very successful modification has been the conversion from
“Low Dose Rate” to “High Dose Rate” brachytherapy.
Using a much higher rate of radioactive decay, “HDR” treatment
is able to deliver that same amount of radiation in a matter of minutes,
as opposed to hours. The
benefit to the patient is as follows: a treatment that takes only minutes
to deliver can be given on an out-patient basis, and thus requires no
admission to hospital for a prolonged period of bed rest.
A brief trip to the operating room is still required so that a
special stent may be placed in the cervical canal for the “HDR”
applicator. This procedure is
also done on an out-patient basis, and full, general anesthesia is not
required.
HDR brachytherapy is not
suitable for all women with cervix cancer.
Eligibility criteria include the size of the cervix cancer and the
woman’s overall state of health. In
appropriate cases, the treatment is extremely well tolerated and
associated with no acute side effects.
It takes only 10 or 15 minutes to deliver, and has a set up time of
approximately 45 minutes. It is given once or twice a week for a total of 5
treatments. Research from
institutions with 10 or more years of experience with this form of
treatment indicates that the tumor cure rate is the same as that
associated with the more traditional “LDR” treatment.
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