Cervical Cancer
Radiotherapy
The objective of radiotherapy is to deliver a high dose of radiation to a volume of treatment in order to maximize tumor control, keeping the dose in nearby tissues as low as possible to reduce the probability of severity of complications in normal tissues.
Clinical data has shown around 50% of patients would benefit from IMRT ( Intensity Modulated Radiotherapy ) treatment, but it must be performed safely, quickly and efficiently from planning to delivery.
Elekta (creators of our radiotherapy equipment, “Versa HD”) developed rotational IMRT, a delivery technique known in Spanish as Modulated Volumetric Arc Therapy (VMAT).
VMAT ( Volumetric Modulated Arc Therapy ) is an advanced radiation therapy technique that delivers high doses of radiation specifically to the target (tumor) while reducing the dose to surrounding tissue and surrounding organs. With the use of single or multiple high-energy rays or particles that move in the form of interrupted arcs around the patient, this technique allows us to drastically reduce treatment times
This gives VMAT of:
- Greater control.
- Greater flexibility.
- Greater dose compliance.
The Elekta VMAT technique allows optimizing the administration of the dose to the needs of each patient, customizing their treatment according to their pathology. In this way, it provides a highly patient-focused procedure, giving us new method opportunities, while offering the freedom to simultaneously vary a number of parameters during the delivery of radiotherapy without having to compromise your treatment plan or its accuracy by time to administer.
Advantages of the VMAT
- Better compliance and dose homogeneity, especially around the spine.
- Lower average doses of OAR (Organs at Risk) vital, such as: heart, thyroid, esophagus,
lung, among others. - Maximum dose reduction in OARs, said dose reduction, could lead to an improvement in
late effects and an increased quality of life.
Radiotherapy in cervical cancer
Cervical cancer or cervical cancer is the third most frequent tumor in women, only in Mexico it is considered the fifth most prominent cancer in 2020, with 9,439 incidences per year.
At the COC we have a radiotherapy team that offers:- Advances in systemic therapy and radiotherapy that have prolonged survival.
- Radiotherapy that reduces the risk of locoregional recurrence after surgery by at least
70%. - Radiotherapy that prolongs survival in early and advanced stages.
- We have the appropriate technology to apply modern techniques that offer long-term
benefits for tumor control and low acute and chronic toxicity.
Situation of cervical cancer in Mexico
- All women are at risk for it. Every year about 4,000 women in Mexico die from this cause, most of which have never been detected.
- Breast and cervical cancer together accounted for 25% of all cancer deaths in women.
- An annual occurrence of 13,960 cases in women is estimated, with an incidence of 23.3 cases per 100,000 women.
- Mexico is the country with the highest mortality from cervical cancer within the countries of the Organization for Economic Cooperation and Development (OECD).
Radiotherapy in the treatment of cervical tumors
The choice of treatment for carcinoma of the cervix depends on the stage of the disease, the volume of the tumor and histology, the probability of involvement of the lymph nodes, the age and the functional status of the patient. Cervical Intraepithelial Neoplasia is treated with superficial ablation techniques. Micro-invasive disease is treated with surgery or cone biopsy, by excision in young patients to preserve fertility. In locally advanced disease primary radiotherapy is the treatment of choice with a careful balance of external beam radiotherapy and brachytherapy (placement of radioactive sources in or near the tumor) to maximize tumor dose and avoid normal tissues.
These treatments can be combined with chemotherapy which improves survival, usually given as a single agent weekly during external beam radiation therapy.
External beam radiation therapy.
VMAT techniques use multiple arc-shaped photon beams that manage to reduce the dose in the small intestine, rectum, and bladder while treating the pelvis. VMAT may also help limit the dose to the pelvic bone marrow in patients undergoing chemoradiation . Organ movement studies have shown that the position of the cervix and uterus vary with the filling of the bladder and rectum. IGRT or Image Guided Radiation Therapy can be used to localize the target volume on a daily basis to ensure treatment is delivered accurately and safely.
Brachytherapy (internal or intracavity radiation) : involves the placement of a radioactive material directly into or next to the tumor using ultrasound guidance, CT, or MRI. It also allows the doctor to use a higher total dose of radiation to treat a smaller area and in less time than is possible with external beam radiation treatment alone.
Brachytherapy allows a very high dose to be administered to the central tumor volume to obtain maximum local control, without exceeding the tolerance of the surrounding normal tissues. This procedure is often indispensable for cancer treatment for most gynecologic tumors because the normal uterus and vaginal vault are relatively strong, a prewritten optimal dose can be delivered to the tumor, and there is a rapid dose taper at a distance from the cervix. uterus, protecting the adjacent rectum, bladder, and small intestine.
Brachytherapy.
Soon we will have a CT-guided 3D Brachytherapy team with which we will provide Interstitial and Intracavitary Brachytherapy treatments that are evaluated in a personalized way for each patient. This consists of the temporary insertion of a radioactive source of Iridium-192, considered as a minimally
invasive and outpatient procedure.