Radiotherapy of uterine cancer
Types of tumours
- T1a- Tumour invades less than 1⁄2 myometrium
- T1b- invades more than 1⁄2 myometrium
- T2- invades stromal connective tissue of cervix, does not extend beyond uterus
- T3- tumour extends beyond uterus- serosa, vagina, parametria
- T4- invades mucosa of adjacent organs bladder and/or bowel
Brachytherapy
- Cylindrical vagina applicator for high dose rate-HDR
- With 192Ir(iridium)
- 3cm long at 0.5cm from surface- dose distribution
Post- operative radiation therapy
Recommended when:
- Tumour invades over 1/3 of myometrium
- High grade tumors- G3
- Metastasis to pelvic lymph nodes- N1
- In pT2, pT3, pT4 after radical operation
- 30-40Gy total dose, 1.8-2Gy daily dose
- pelvic lymph node metastasis- 50Gy total dose
Radical radiation therapy
- Inoperable patients
- EBRT alone or EBRT combined with brachytherapy
Combined radiation therapy
- For curative effect
- brachytherapy and EBRT
- to ‘point A’- EBRT 30-40Gy and intracavitary 70-80Gy
- to ‘point B’- EBRT to lateral part of the pelvis 60Gy
Definitive radiation therapy
- when brachytherapy cannot be performed
- EBRT 60Gy total dose
Palliative Radiation therapy
- Improve quality of life
- 30-40Gy total dose
Follow-up
- After RT- at week 4-6
- Year 0-2- every 3 months
- Y3-5- every 6 months
- After y5- once a year
- Chest x ray and CT
- Gynaecological exam etc