Radiotherapy for gynaecological and breast cancersVienaMed
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In the face of an oncologic diagnosis, the choice of appropriate treatment may raise numerous questions:
Is radiotherapy necessary? What technology is best suited? Is surgery needed? Can radiotherapy be combined with chemotherapy or immunotherapy? Is a second medical opinion worth asking?
By VienaMed, Romanian patients seeking evaluation and treatment in Vienna can receive support for accessing specialists and medical centres suitable for their situation.
Analysing medical documents and obtaining a multidisciplinary assessment may be particularly important before a complex oncological treatment is started.
Radiotherapy in the treatment of female cancers: when recommended and how modern technologies help
Radiation therapy is one of the main treatment methods in modern oncology and can play a role curative, adjuvant or palliative, depending on the type of cancer, the stage of the disease, the location of the tumor and the particularities of each patient.
In female cancers – such as cervical cancer, breast cancer, endometrial cancer or certain forms of ovarian cancer – radiotherapy can be part of a complex therapeutic plan, together with surgery, chemotherapy, targeted therapies and immunotherapy.
Technological advances in recent years allow radiation to be administered with increasing accuracy so that the tumor is given the required dose and the surrounding healthy tissues are protected as much as possible.
What is the role of radiotherapy in the treatment of cervical cancer?
Cervix cancer is one of the important examples in which radiotherapy may have curative intent.
Especially in locally advanced forms, treatment may involve the combination of:
- external radiotherapy;
- concomitant chemotherapy;
- brachytherapy;
- and in certain situations, immunotherapy or other systemic treatments.
In stages IIB, III and IVA of cervical cancer, chemotherapy-associated radiotherapy is one of the main therapeutic variants, and treatment frequently includes both external radiotherapy and brahiterapy.
However, the therapeutic plan should be determined individually depending on the disease extension, the histological and molecular characteristics of the tumour, the overall condition of the patient and any associated diseases.
Radiation therapy in breast cancer
In breast cancer, radiotherapy often serves as an adjuvant after surgery to reduce the risk of a local recurrence.
The need for radiotherapy and the area to be treated are determined by several factors: type of surgery, tumour size, lymph node damage, biological characteristics of the cancer and individual risk of relapse.
Thus, two patients with the same apparent diagnosis may have different regimens.
What are the main types of radiotherapy?
Modern radiotherapy does not mean a single technique. Depending on the type and location of the tumor, the radiotherapist doctor can use different methods.
External radiotherapy
External radiotherapy uses an apparatus that directs radiation beams to the tumor area. It is a local treatment, targeted at a precise region of the body.
Modern techniques include:
IMRT – Intensity-Modulated Radiation Therapy
Allows to change the intensity of the radiation beams to better adapt the dose to the shape of the tumor and to reduce the exposure of healthy tissues.
VMAT – Volumetric Modelled Arc Therapy
It is an advanced technique by which the device rotates around the patient and gives the radiation from multiple angles.
Tomotherapy
It combines the administration of radiotherapy with imaging technologies that allow very precise positioning and treatment of certain tumour volumes.
Proton therapy
Protontherapy uses protons instead of photons used in conventional radiotherapy.
One of the important features of this technology is the possibility to control more precisely where the energy is released, reducing in certain situations the dose received by healthy tissues around the tumor.
However, protontherapy is not automatically the best option for any cancer. The indication must be determined individually by the oncology team.
Brahiterapia
Brahiterapia is a form of internal radiotherapy through which the radiation source is positioned inside or very close to the tumor, with the help of applicators or catheters.
This method allows the administration of a high dose in a very well-defined area and is used, among other things, in the treatment of cervical cancer and other selected tumours.
What does curative radiotherapy and palliative radiotherapy mean?
The purpose of radiotherapy differs from patient to patient.
Radiotherapy with curative intent
It is used when the objective of the treatment is complete control of the tumor and, when the oncologic situation allows, healing the disease.
It can be given alone or in combination with surgery, chemotherapy, immunotherapy or other oncologic treatments.
In some types of cancer, radiotherapy may be the primary treatment.
Palliative radiotherapy
When the disease is advanced, radiotherapy can be used for control of symptoms and improvement of quality of life.
For example, it can contribute to:
- pain reduction;
- bleeding control;
- relief of symptoms caused by certain metastases;
- reducing the compression exerted by a tumor on nearby structures.
The palliative treatment regimen may involve one or more sessions depending on the clinical situation and the therapeutic objective.
How does IGLT and modern technologies help?
IGT – Image-Guided Radiation Therapy means imaging-guided radiotherapy.
Before or during treatment, images are used to check the location of the tumor and surrounding organs.
This is important because the position of some anatomical structures may change from day to day and the treatment should be given very precisely.
The combination of technologies such as IGT, IMRT or VMAT allows doctors to better focus the dose on the area to be treated and to limit exposure of healthy organs as far as possible.
The objective of modern radiotherapy is clear: greater accuracy, better tumour control and reduced treatment toxicity.
What side effects can radiation therapy have?
The side effects depend heavily on:
- the treated area;
- dose administered;
- number of meetings;
- volume of irradiated tissue;
- concomitant treatments;
- general patient status.
One of the most common symptoms is fatigue. Other side effects specific to the treated region, such as skin changes, digestive or urinary problems and, when the pelvic area is irradiated, effects on sexual function or fertility may occur.
Some reactions occur during treatment and subsequently improve, while some late effects may occur after months or even years.
Therefore, monitoring of the patient after the end of radiotherapy remains an important part of oncological care.
What types of cancer respond well to radiotherapy?
The sensitivity to radiation varies depending on the histological and biological type of the tumor.
Squamous carcinomas, also found in cervical cancer and certain cancers in the ORL sphere, can have a very good response to radiotherapy.
Other tumour types, including many adenocarcinomas, can be effectively treated by radiotherapy when there is the appropriate indication.
In current oncology, however, it is increasingly important that we not only talk about „the type of cancer,” but also about exact location, stage of disease, molecular profile, prior treatments and individual characteristics of the patient.
Are there cancers that can't be treated by radiotherapy?
In the past, certain tumors, such as melanoma or kidney cancer, were considered relatively resistant to radiotherapy.
The development of modern stereotactic techniques has, however, significantly changed the approach of such cases.
Stereotactic radiotherapy may administer very high and very precise doses in a small number of sessions, being used in carefully selected situations, including for certain metastases.
Therefore, the decision to use radiotherapy or not should not be made solely on the basis of the name of the cancer.
Radiotherapy and immunotherapy - an important direction in oncology
One of the important directions for research and development is the association of radiotherapy with immunotherapy.
Radiation therapy can cause changes in the tumor and tumour microenvironment, and research is looking at how these effects can be harnessed together with medicines that stimulate the response of the immune system against cancer.
However, the indication of such a combination depends on the exact diagnosis and oncology protocols applicable to each patient.
For explanations about this treatment option, consult the article on immunotherapy in cancer.
Artificial intelligence is already starting to be used in radiotherapy
Artificial intelligence is becoming more and more present in radiotherapy planning.
It may contribute to:
- delimitation of anatomical structures;
- identification of the bodies to be protected;
- optimisation of the treatment plan;
- automation of certain stages;
- verification of the quality of the therapeutic plan.
However, the role of the doctor and radiotherapy team remains essential. Each plan must be analysed and adapted to the real medical situation of the patient.
The future is heading towards more and more personalized, more precise and better adapted to the biology of each tumor.
What is the most aggressive female cancer?
There is no universal response. A breast cancer may have a slow evolution or may have very aggressive biological characteristics. The same applies to other gynecological tumors. In cervical cancer, for example, most cases are squamous carcinomas, but there are also adenocarcinomas and other subtypes that may have different biological characteristics.
Ovarian cancer is often diagnosed at an advanced stage, which makes it a complex pathology. However, new systemic therapies have significantly improved treatment possibilities for certain patients. Therefore, prognosis should not be determined solely from the organ in which the cancer occurred. The stage, histology, molecular profile and response to treatment are essential.
Did you get an oncology diagnosis and want an evaluation in Vienna?
VienaMed can help you gain access to specialists and modern diagnostic and oncological treatment options in Vienna.
Whether it’s about a second medical opinion, assessment of an indication of radiotherapy or establishment of a complex therapeutic plan, each case should be individually analysed.
Contact VienaMed for information and for a medical evaluation in Vienna.
The information given in this Article shall be informative and shall not replace the consultation, diagnosis or recommendation of a specialist doctor.
Can you read and when a second oncological opinion may be useful before discussing the options with the medical team.