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Cervical cancer and endometrial cancer (Gynecologic cancer)

Radiation therapy is one of the essential components in the gynecology field for primary nonsurgical management and adjuvant post-operative treatment of certain malignancies arising in the female reproductive tract.

Radiation therapy is given as external beam radiotherapy to the pelvis and brachytherapy in the treatment of patients with cervical cancer or endometrial cancer. For certain high-risk patients, in addition to chemotherapy, the external beam radiotherapy will encompass the pelvis and para-aortic region; this so called extended-field radiotherapy (EFRT) will inevitably increase acute treatment-related gastrointestinal and hematological toxicity. With the advancements of radiotherapy technology in recent years, modern techniques including intensity-modulated radiotherapy (IMRT), RapidArc volumetric modulated arc therapy (VMAT), and image-guided radiotherapy (IGRT) have allowed for precise radiation beam delivery to the target volumes, thus avoiding unnecessary normal organ radiation exposure and significantly reducing side effects.

A proton beam has the Bragg peak, which means that a large amount of energy is released at the desired depth, but the entrance dose is low and no dose exists beyond the desired depth. Little has been done regarding proton treatment in gynecological malignancies because the uterus and cervix are mobile organs, making it difficult to precisely irradiate a malignancy by proton beam. However, for patients that need to be treated with EFRT, a combination treatment with photon and proton beams to treat the pelvis and para-aortic region, respectively, would potentially reduce the bowel complications of extended-field RT.

Article author: Dr. Yi-Ting Huang