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Update:2014/05/12

Cervical cancer

Cervical cancer is a malignant neoplasm arising from cells originating in the cervix uteri. It is one of the common gynecologic cancers in Taiwan, and it remains a leading cause of cancer-related death for women in Taiwan. Human papillomavirus (HPV) infection appears to be a necessary factor in the development of almost all cases (90+%) of cervical cancer. Cancer screening using the Pap smear can identify precancerous and potentially precancerous changes in cervical cells and tissue. In developed countries, the widespread use of cervical screening programs has dramatically reduced the incidence of invasive cervical cancer.

The standard treatments for patients with cervical cancer include surgery, radiation therapy and chemotherapy. Early stages (IB1 and IIA less than 4 cm) can be treated with radical hysterectomy with removal of the lymph nodes or radiation therapy. Radiation therapy is given as external beam radiotherapy to the pelvis and brachytherapy. Patients treated with surgery who have high risk features found on pathologic examination are given radiation therapy with or without chemotherapy in order to reduce the risk of relapse. Advanced stage tumors (IIB-IVA) are treated with radiation therapy and cisplatin-based chemotherapy. Five randomized, phase III trials (GOG-85, RTOG-9001, GOG-120, GOG-123, and SWOG-8797) have shown an overall survival advantage for cisplatin-based therapy given concurrently with radiation therapy.

With the advance of radiotherapy technology in recent years, modern techniques including three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), RapidArc volumetric modulated arc therapy (VMAT), and image-guided radiotherapy (IGRT) enable precise radiation beam delivery to the target volumes and avoid unnecessary normal organ radiation exposure, and the side effects are remarkably reduced. However, there is still unpreventable substantial dose scattering to surrounding normal tissue by X-ray.

Proton beam has the Bragg peak which means a large amount of energy is released at the desired depth, but the entrance dose is low and no dose exists after the desired depth. There was little experience about proton treatment in gynecological malignancies because the uterus or cervix were mobile organ, which was difficult to be precisely irradiated by proton beam. However, there were emerging comparison study about treatment planning between proton beam and photon beam in the treatment of para-aortic region, which implies the potential role of proton to reduce bowel complication during extended field RT.。

Article author: Dr. Yi-Ting Huang