Breast and gynecological malignancies- Radiation oncologist perspective

Every year more than 10 lacs new cancer patients are diagnosed in India. Earlier cancer cervix followed by cancer breast were the most common cancers amongst females. Now situation has been reversed.

Breast cancer-

 Radiation therapy has an important role in treating all stages of breast cancer.

• After breast-conserving surgery (BCS), to help lower the chance that the cancer will come back in the breast or nearby lymph nodes
• After a mastectomy, if the disease is locally advanced
• If disease has spread to other parts of the body, such as the bones or brain

In India, now more and more numbers of patients being diagnosed with breast cancer to be in the younger age groups (in their thirties and forties).People are also becoming aware about the disease. At early stage and younger age group breast conservation surgeries with oncoplastic surgeries are becoming quite often. Radiotherapy to breast is part and parcel of this conservation surgery.

With the newer techniques of radiotherapy (intensity modulated radiotherapy IMRT, image guided radiotherapy IGRT), skin changes and fibrosis has become less common hence cosmesis is good. High dose to normal structures such as lung , heart has also been minimized.

With addition of radiotherapy after breast conservation surgery local failure has been reduced from 40% to 12%.(NSABPB-06).

After mastectomy radiation decrease 16% chances of recurrence.(Lancet 2014)

Cervix cancer

The primary treatment of early stage cervical cancer is either surgery or radiotherapy (stage IA, IB1 and selected IIA1). Radiation along with chemotherapy is generally the primary treatment of choice for Stage I B2 to IVA.

Some patients may need postop radiotherapy depending upon risk factors (large size, positive margin, positive node, deep stromal invasion etc).

With older techniques of radiation side effects related to bladder , rectum and intestine were quite common. With newer modalities (IMRT, IGRT, SBRT) these side effects has been decreased because of less radiation exposure of normal tissues.

Stage 1 has 80% chances of cure while sage II has 60% chances. This cure rate is same for both modalities surgery or radiotherapy. Post op radiotherapy decreases 30% chances of recurrence.(AJCC2010)

Endometrial cancer

Radiotherapy is used as postop treatment to decrease the chances of disease to return even in stage I. It depends upon many risk factors such as age, myometrial invasion, grade, nodal involvement etc.

In some cases when disease is inoperable due to co morbidities, radiation can be used.

In stage I depending upon grade, there is 10-14% chances of disease recurrence at vagina and 30% chances at pelvic nodal region.(Lancet 2000)

External Beam Radiotherapy

Brachytherapy

Brachytherapy in an important part of gynecological treatment. In this technique some instruments are palced inside the body throughwhich radiation is given. This is a OPD basis procedure

Conclusion

Currently radiotherapy occupies a major role in the treatment of cancer.The previous two decades have brought great technological innovations in the field of radiation oncology with improved ability of targeting radiation dose to the tumor.

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