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RADIOTHERAPEUTIC ANDRADIOTHERAPEUTIC AND

ONCOLOGICALONCOLOGICAL

TREATMENT OF CANCERTREATMENT OF CANCER

OF THE CERVIXOF THE CERVIXBY

DR SHAGAYA U. N.

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INTRODUCTION PRE TREATMENT EVALUATION STAGINGTREATMENT OPTIONS

RADIOTHERAPY CHEMORADIATION CHEMOTHERAPY COMPLICATIONS

RECURRENT DISEASE PROGNOSIS CONCLUCION

OUTLINEOUTLINE

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INTRODUCTIONINTRODUCTION

A major health public health problem. About 0.5Million new cases occur annually

worldwide. WHO 2002. Vast majority occurs in the developing

countries. Commonest female genital cancer in

developing countries.

Account for 231,000 deaths annually . 80% occurs in developing countries. Parkin et al 2000.

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Over 25,000 new cases are seen in Nigeriaannually i.e. 480cases per week.

SolankeT.F.1996. At the UCH Ibadan 2-5 new cases are seen

weekly Edozien &Adewole 1993

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AETIOLOGYAETIOLOGY

INFECTIOUS AGENTSLargely regarded as STD

Sexually transmitted Human papilloma virus(HPV) implicated Types 16 and 18 (associated

with 70-80% of cervical cancers)HIV infection

Associated with faster progression of preinvasive disease.

Smoking

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Radiation therapy [XRT] is a clinical modality

dealing with the use of ionising radiation intreatment of patients with malignantneoplasias and occasionally benign dx.

The aim of XRT is to deliver a precisely

measured dose of irradiation to a definedtumour volume with as minimal damage aspossible to surrounding healthy tissueresulting in eradication of the tumour, highquality of life &prolongation of survival at

competitive cost. In addition to curative effort XRT plays a

major role in cancer mgt in effectivepalliation or prevention of symptoms of

disease.

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The biologic effects of ionizing radiation arelargely the result of DNA damage, which iscaused directly by ionization within theDNA molecule or indirectly from the action

of chemical radicals formed as a result oflocal ionization in water.

Following exposure to radiation cells maydie attempting the next mitosis [mitotic

death] or they may die programmed celldeath [apoptotic death]

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History and physical examination For stage II B, III or IV A disease or for

symptoms perform cystoscopy,sigmoidoscopy and/or barium enema

Labs Imaging

PRE TREATMENTPRE TREATMENT

EVALUATIONEVALUATION

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STAGE I-Confined to the cervix STAGE IA-

Invasive carcinoma diagnosed microscopically onlymax depth 5mm max width 7mm STAGE IB-Macroscopic tumour size>IA

STAGE II-Invades beyond the cervix to upper 2/3rd ofthe vagina STAGE IIA-No

parametrial involvement STAGE IIB-Withparametrial involvement

STAGE III- Extends to lower 1/3rdof the vagina, pelvicside wall, causes hydronephrosis or non-functioningkidney

STAGE IIIA-Extends to the lower third of vaginabut not to the pelvic side wall STAGEIIIB-Extends to pelvic side wall or causeshydronephrosis or non-functioning kidneys

STAGING -FIGOSTAGING -FIGO

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STAGE IV-Extends beyond the true pelvis orhas clinically involved the mucosa of thebladder or rectum STAGE IVA-Spread to adjacent organs bladder/rectum

STAGE IVB-Spread to distantorgans

STAGINGSTAGING

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RADIOTHERAPY Indication for XRT

-Goal of XRT -Planned TX volume -Planned technique -Planned TX dose

Simulation position, field and borders

TREATMENT OPTIONSTREATMENT OPTIONS

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External beam radiotherapyTreat with 4 field or AP/PA technique Borders -Superior =L4/5, Inferior=3cm below

most inferior vaginal involvement,

Lateral=2cm lateral to pelvic brim,posterior=include entire sacrum, anterior=1cm anterior to pubic symphsis

Dose -40Gy in 20# AP/PA, 14Gy in 7# lat

using photons EFRT for Para aortic nodes

RADIOTHERAPYRADIOTHERAPY

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Radiation treatment with source placedclose to the tumour

Proceed when tumour is

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Chemo radiation- Cisplatinum, 5-FUwith/without Mitomycin C

In hypoxic or oxygenated cells free radicalswith altered binding of platinum to DNA

are formed at the time of irradiation Interaction inhibits repair of sub lethal

damage

CHEMORADIATIONCHEMORADIATION

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ACUTE SEQUELAE Diarrhoea, abd cramping, rectal

discomfort/bleeding Dysuria, frequency and nocturia Erythema and dry or moist desquamationThromboembolism Uterine perforation

Rare sepsis, pulmonary dx, arterialhypotension, change in mental status andmyocardial infarction

COMPLICATIONSCOMPLICATIONS

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Chemotherapy Radiotherapy

RECURRENT DISEASERECURRENT DISEASE

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Prognostic factors Age Race/socioeconomic status Anaemia and tumour hypoxiaTumour volume Histology

PROGNOSISPROGNOSIS

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Radiotherapy is a main mode ofmanagement of ca cervix

Not enough radiotherapy centres Hope for improvement HPV vaccine

CONCLUSIONCONCLUSION

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THANK YOU FORTHANK YOU FOR

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