General
Radiation therapy consists of a combination of percutaneous (“through the skin“) and afterloading therapy (synonym: afterloading procedure; radiation therapy from “inside”. For this purpose, a sleeve is inserted into the organ in question (in this case, the vagina/vagina), and the radiation source is then automatically moved into the sleeve, i.e., it is “reloaded.” After irradiation, the radiation source is withdrawn and the sleeve is removed). The combination of these two methods reduces the local recurrence risk (risk of tumor recurrence at the same site) but does not improve survival.
Primary radiotherapy-radiochemotherapy (RCTX)
Radiatio (radiotherapy) in combination with cisplatin (chemotherapy drug), which increases the radiosensitivity of tumor cells (called a radiosensitizer), is now standard. It improves, in contrast to radiatio alone
- The progression-free interval
- The local recurrence rate (recurrence of the tumor at the same site).
- The survival time
There are the following indications for primary radiochemotherapy (RCTX).
- In stage FIGO IB1-IIA, primary radiotherapy is equivalent to surgery, decision based on comorbidities/concomitant diseases; however, standard therapy is surgery, especially in premenopausal patients (women before menopause), because the ovaries (ovaries) do not need to be removed
- Simultaneous cisplatin-containing radiochemotherapy (RCTX) in stage FIGO IIB, III is standard procedure.
Combined radio-chemotherapy is performed with cisplatin as monotherapy usually once weekly, 5 cycles, at low doses (40 mg/m²)
Further notes
- In a study of patients in stages B2, IIA, or IIB, the results of primary combined radiochemotherapy (RCTX) compared with neoadjuvant chemotherapy (NACT) for disease-free survival (“DFS”) showed no significant difference (median follow-up: 58.5 months): 69.3% for NACT versus 76.7% for RCTX (p = 0.038).
Postoperative radiotherapy/combined radiochemotherapy (RCTX)
- Postoperative radiotherapy alone (percutaneous + afterloading) reduces the risk of local recurrence
- A combination radiatio + chemotherapy is more effective from the aspect:
- Of the progression-free interval
- Of local recurrences
- Of survival time
The following indications are known for postoperative radiotherapy/combined radiochemotherapy (RCTX):
- Inadequate lymphonodectomy (lymph node removal).
- Extensive involvement of lymph nodes and vessels.
- Large tumors > 4 cm
- Deep invasion into the tissue
- Resection (surgical removal) with microscopic tumor remnant (R1).
- Extensive infiltration of the parametria (connective tissue structures of the pelvic cavity that extend from the wall of the cervix to the urinary bladder, the os sacrum (sacrum), and the internal lateral wall of the pelvis).
- Inoperability of recurrences
Combined radiochemotherapy (RCTX) is given with cisplatin as monotherapy usually once weekly, 5 cycles, at low doses (40 mg/m²)
Further notes
- In women with FIGO stage IIIb squamous cell carcinoma of the cervix, progression-free and overall survival are higher with combined radiochemotherapy (RCTX) than with radiation alone.
- In a study of patients in stages B2, IIA, or IIB, the results of primary combined radiochemotherapy (RCTX) compared with NACT for disease-free survival (DFS) showed no significant difference (median follow-up: 58.5 months): 69.3% for NACT versus 76.7% for RCTX (p = 0.038).
Emergency radiotherapy for severe tumor bleeding
It can be performed both percutaneously and intravaginally (“inside the vagina”) as an afterloading to stop bleeding.
