Radiotherapy to the female pelvis Dr Sherif Raouf MB BCh FRCR Consultant Clinical Oncologist BHRUT

How does radiotherapy works? Mechanism of action: radiation induce damage of tumour cell DNA, preventing cell division and causing cell death

Radiotherapy uses Curative indications: Palliative indications: Cervical cancer 52% 5 yr OS. Bladder cancer Anal cancer Endometrial cancer Rectal cancer Palliative indications: Any tumour type for pain and symptom control

Radiotherapy planning Procedure for giving radiotherapy Diagnosis Radiotherapy planning Treatment delivery

Radiotherapy planning Patient positioning Lasers Tattoos Immobilisation To ensure reproducibility in a multi-fraction radiotherapy course

Positioning lasers 6

Radiotherapy side effects Early (Acute): Occur during the course of the treatment Recover soon after the therapy is completed Late (chronic): late radiation complications are due to small vessel injury with endothelial damage, inflammation, fibrosis, ischaemia and necrosis. Occur months to years after a course of radiotherapy Tend’s to be permanent …..

Early Radiotherapy side effects Fatigue Skin desquamation Diarrhoea Low blood count Frequency / cystitis

Skin desquamation

Late side effects Skin telangectasia Vaginal stenosis Dilators Late effects on bowels (proctitis) Bladder changes Avascular necrosis of the hip Secondary cancer

Sexual morbidity Sexual problems suffered by women with cervical cancer may include: loss of libido change in sexual activity and decreased orgasm. Up to 65% of women experience one or more of these problems due to vaginal dryness or bleeding. Vaginal stenosis and dyspareunia. atrophic vaginitis and pain.

Skin telangectasia

Vaginal dilators

Sparing normal tissues is not an easy task

Intensity modulated radiotherapy (IMRT)

Using multiple fields allows for better sparing of normal tissues

Summary Radiotherapy is effective in treating pelvic cancers. Acute radiotherapy side effects recover shortly after therapy ends. Late effects tends be permanent and can take months to years to manifest. New radiotherapy techniques allows for better tumour control with good sparing of normal tissues.