Cervical cancer Radiotherapy

Radiotherapy is a cancer treatment in which, depending on the technique, different types of radiation are used to kill cancer cells. In the case of cervical cancer, radiotherapy is considered an equivalent choice to surgery or is used when surgery is not possible. Sometimes radiotherapy is also recommended as an additional treatment after surgery. Radiotherapy is often combined with chemotherapy to improve its effectiveness.

Procedure

So-called curative radiotherapy is used to cure cervical cancer, either alone or in combination with surgery and drug therapy. If the cervical cancer has already spread, so-called palliative radiotherapy can prevent or alleviate the symptoms caused by metastases, e.g. in the lungs or bones.

For many patients, we are already offering the treatment of tomorrow: in clinical trials, we are continuously working on improving the treatment of cervical cancer to make it even more effective and tolerable.

Each patient is discussed in detail by a panel of experts from all relevant specialist areas. After this discussion, the patient is presented with the optimal choice of treatment and her wishes and opinions are taken into account. Personal support is a matter of course for us.

Types of radiotherapy for cervical cancer

Two types of radiotherapy can be used for cervical cancer: radiotherapy from the outside and radiotherapy from the inside.

In external radiation therapy, a linear accelerator is used to send focused high-energy X-rays onto the tumor from the outside, killing it in a targeted manner. External radiation therapy is carried out as an outpatient treatment, does not require anesthesia and can be easily integrated into everyday private and professional life. The treatments are not painful and only take a few minutes each. As a rule, treatment is fractionated, which means that the radiation dose is divided into daily fractions. The treatment takes place five times a week over a period of approximately six weeks. The USZ uses only the most modern technology to achieve a personalized and precise dose distribution in the tissue.

Radiotherapy from the inside, also known as internal radiotherapy or brachytherapy , requires a short inpatient stay in our department. Brachytherapy is a clinical and scientific focus of Primoz Petric, an internationally recognized expert in this field, who passes on his knowledge at international congresses, courses and through publications. During brachytherapy, the radiation source is inserted into the cervix under brief anesthesia or sedation and destroys the tumor cells at close range. The radiation only travels a short distance, so that healthy tissue in the vicinity does not receive a high dose and is optimally protected. After the treatment, the source is removed from the body and the patient does not emit any radioactivity, so she can leave the hospital and return to her normal private life. Typically, four such treatments are required to achieve the best effect. The USZ uses the latest technology of magnetic resonance or computer tomography-guided brachytherapy. This technique enables highly precise and personalized delivery of the radiation dose to the tumor and maximum protection of healthy tissue.

You will be looked after by internationally recognized experts in the research and treatment of uterine cancer. The irradiation of cervical cancer with a modern magnetic resonance guided technique is a clinical and scientific focus of Prof. P. Petric. He passes on his knowledge in a large number of international courses and congresses and is active as an international expert in guideline commissions. He is involved in research and development activities that have an impact on the global field of cervical cancer radiotherapy.

The Department of Radiation Oncology at the USZ uses only the most modern techniques for precise radiation treatment of cervical cancer with few side effects. State-of-the-art equipment and experienced medical staff contribute to treatment of optimum quality and safety. Our team works closely with our colleagues in gynecology and medical oncology to guarantee “one-stop” treatment.

For many patients, we are already offering tomorrow’s treatment today: in clinical trials, we are continuously working on improving the treatment of cervical cancer to make it even more effective and tolerable. To the overview of currently open studies.

In the following, we will describe radiotherapy for the different types and stages of cervical cancer.

Cervical cancer at an early stage

The majority of patients with early-stage cervical cancer are treated surgically. In some cases, the cancer may have characteristics that are associated with an increased risk of recurrence. In these cases, additional radiotherapy with chemotherapy may be recommended to improve the treatment outcome, reduce the risk of relapse and increase the chances of recovery. In these cases, five weeks of external radiation therapy is typically recommended.
In the case of early-stage cervical cancer, surgery can sometimes be avoided altogether. In this case, the patient is treated with a combined therapy: first, external radiotherapy is carried out for about five weeks and a light chemotherapy is administered in parallel. This is usually followed by four sessions of brachytherapy.

The chances of recovery from surgery (with or without additional radiotherapy) and combined radiotherapy and chemotherapy without surgery are equivalent and excellent. However, they differ in terms of treatment duration and side effects. We always involve our patients in the decision-making process in order to tailor the treatment to their individual needs.

In clinical trials, we are continuously working on improving the treatment of cervical cancer to make it even more effective and tolerable. To the overview of currently open studies.

Cervical cancer in the locally advanced stage

In locally advanced stages, radiotherapy with simultaneous chemotherapy followed by brachytherapy is the treatment of choice. In these situations, surgery is not recommended as the primary treatment. However, we work closely with our colleagues in gynecology and medical oncology to provide each of our patients with the most modern and personalized treatment.

Over the last 15 years, the chances of recovery for patients in this group have improved considerably and the side effects have been significantly reduced. This is mainly due to the improvements in radiotherapy, especially brachytherapy techniques, that have taken place during this time. Members of our gynecology treatment team have been at the forefront of these developments and use this knowledge every day in the treatment of their patients.

In clinical trials, we are continuously working on improving the treatment of cervical cancer to make it even more effective and tolerable. To the overview of currently open studies.

Metastases of cervical cancer, e.g. in the brain or bones

Uterine cancer is an aggressive type of cancer that often forms metastases during the course of the disease: this is called metastasis. Common sites of metastasis are the lung, adrenal gland, bones, liver or brain. Radiotherapy is a highly effective method with few side effects to prevent or treat symptoms caused by metastases. This is usually done in combination with chemotherapy, immunotherapy or other targeted therapy. The smaller the metastases are and the earlier they are irradiated, the better the results. Today, metastases in the body can be treated in a focused manner in just a few effective radiation sessions.

For tumor foci in the abdominal area, e.g. liver or upper abdomen, we carry out body stereotactic radiotherapy (SBRT) on our MRI hybrid accelerator. State-of-the-art radiation technology is combined with MRI images. The radiation is thus carried out under MRI monitoring of the tumor, so that the highest precision is combined with the best imaging. Our clinic was the first in Switzerland to introduce this technology back in 2019. We are still the only clinic in German-speaking Switzerland to offer the highest level of expertise in this field.

Today, brain metastases are treated at our center in most patients by means of a single high-dose radiation treatment: this is called radiosurgery.

Metastases at other locations in the body can now also be treated in a focused manner in just a few effective radiation sessions. Metastatic uterine cancer is a clinical and scientific focus of our clinic. We pass on our knowledge in a large number of international courses and congresses. We are active as international experts in guideline commissions.

State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety. At the same time, we work closely with our colleagues in medical oncology to guarantee “one-stop” treatment. We also consult with our colleagues in palliative medicine at an early stage.

In clinical trials, we are continuously trying to improve the treatment of uterine cancer in order to make it even more effective and tolerable. To the overview of currently open studies.

  • Results of image guided brachytherapy for stage IB cervical cancer in the RetroEMBRACE study. Petric P, et al. Radiother Oncol 2021;157:24-31
  • Randomized study between radical surgery and radiotherapy for the treatment of stage IB-IIA cervical cancer: 20-year update. Landoni F, et al. Journal of Gynecol Oncol 2017;28(3):e34.
  • MRI guided adaptive brachytherapy in locally advanced cervical cancer: overall results. Pötter R (and Petric P), et al. The Lancet Oncol 2021; ahead of print.
  • Image guided brachytherapy in locally advanced cervical cancer: Improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study. Sturdza A, (and Petric P) et al. Radiother Oncol 2016;120(3):428-433.
  • MRI-assisted cervix cancer brachytherapy pre-planning, based on application in paracervical anaesthesia: final report. Petric P, et al. Radiol Oncol 2014;48(3):293-300.
  • Management of oligo-metastatic and oligo-recurrent cervical cancer: A pattern of care survey within the EMBRACE research network. Chopra S, et al. Radiother Oncol 2021;155:151-159.
  • Characterization and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation. Guckenberger M, Lancet Oncol. 2020(1):e18-e28.

Responsible professionals

Primoz Petric, Ph.D., Prof. Dr. med.

Attending Physician with extended responsibilites, Department of Radiation Oncology

Tel. +41 44 255 26 73
Specialties: , ,

Claudia Linsenmeier, Dr. med.

Attending Physician with extended responsibilites, Department of Radiation Oncology

Tel. +41 44 255 26 73
Specialties: Focus on breast/gynecology, Gastro-Intestinal Radio-Oncology, Pediatric radio-oncology

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