Cervical cancer, like all cancers, has different treatment modalities and often there is a need for multiple approaches to therapy involving surgery, radiation therapy and/or chemotherapy. The choice of treatment should take into account both efficacy and safety. That is to say that both doctor and patient must discuss the potential side effects of these therapies. A recent study published in the Practical Radiation Oncology journal gives new insight into the side effects of a specific type of radiation therapy: Extended-Field Intensity Modulated Radiation Therapy.
Radiation therapy is indicated to treat not only the visible cancer by imaging studies, but also to treat microscopic spread of cancer cells and prevent relapse of the disease, further increasing the chances of cure. This need comes from the fact that surgery is unable to remove all cancer cells that are sometimes out of the primary tumor site and the fact that PET/CT scans, commonly used to evaluate how advanced is the disease, are unable to detect cancer spreads to lymph nodes in up to 1/4 of patients. Extended-field intensity modulated radiation therapy is a modality of radiation therapy that includes not only the pelvis but also some of the abdomen (namely the para-aortic lymph nodes) to increase the chances of cure. But, greater efficacy comes with a potential higher rate of side effects.
A team of researchers from the University of Pittsburgh Cancer Institute led by senior author Dr. Sushil Beriwal looked at the frequency of duodenal (a part of the small intestine) toxicity in 76 patients undergoing extended-field intensity modulated radiation therapy for cervical or endometrial (uterus) cancers, a side effect incidentally reported in some previous studies. Their results showed that after a mean follow-up of more that 1,5 years, whilst using a normal prescribing dose of radiation therapy, the rate of duodenal toxicity was low. Only three patients had serious side effects requiring hospitalization or surgery.
These findings enhance the role of extended-field intensity modulated radiation therapy for gynecologic cancers and provides additional information for a more shared and informed treatment choice by the patients. It ensures that these treatments, when indicated, are not only effective, but also have low side effects, an important variable while choosing patients for this type of radiation therapy who are also frequently treated with adjuvant chemotherapy.