Treatment-related toxicity from the use of radiation therapy for gynecologic malignancies
- Kristin A Bradley, MD
Kristin A Bradley, MD
- Associate Professor
- University of Wisconsin School of Medicine and Public Health
- Derek R McHaffie, MD
Derek R McHaffie, MD
- Attending Physician
- Levine Cancer Institute
- Carolinas Medical Center
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Arno J Mundt, MD
Arno J Mundt, MD
- Section Editor — Radiation Therapy
- Chairman of Radiation Oncology
- University of California, San Diego
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Clinical Co-Director, Gynecologic Oncology
- Founder and Director, The Oncology Sexual Health Clinic
- Massachusetts General Hospital Cancer Center
- Associate Professor of Medicine
- Harvard Medical School
Radiation therapy (RT) represents an important therapeutic component in the management of many gynecologic malignancies. Based upon evidence-based treatment guidelines, RT is indicated in up to 60 percent of cervical cancer patients, 45 percent of endometrial cancer patients, 35 percent of vulvar cancer patients, 100 percent of vaginal cancer patients, and 5 percent of patients with ovarian cancer [1,2].
In this topic, the spectrum of both acute and late side effects associated with RT, specifically as it relates to the treatment of gynecologic malignancies, will be reviewed. An understanding of potential side effects is important for patient management and survivorship issues. An overview of the general principles, modalities, and techniques of RT is found elsewhere. A more detailed discussion of the indications for RT for specific cancer sites and stages can be found in topic reviews for each cancer site. (See "Radiation therapy techniques in cancer treatment".)
Radiation therapy (RT) for gynecologic cancers can be employed as primary treatment or following surgery or before surgery (ie, adjuvant therapy) in order to reduce the risk of recurrence. For some tumors, RT is often administered with concurrent chemotherapy (chemoradiation) and may incorporate brachytherapy. The normal tissues of the cervix and corpus of the uterus can tolerate high doses of radiation and can recover remarkably well from radiation injury. However, the surrounding normal tissues are more susceptible to radiation injury.
The incidence and severity of RT side effects depend upon the site, volume of tissue exposed, and treatment schedule, including total dose, dose per fraction, and type of radiation. Modifying factors such as previous surgery, concomitant chemotherapy, and comorbid illness are also influential. At least one large report indicates that smoking history is a strong predictor for both bowel and bladder complications from treatment .
Some patients may be at higher risk for RT-related toxicity. These include patients with:
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- TIMING OF RT-RELATED TOXICITIES
- GENITOURINARY SYSTEM TOXICITIES
- Acute radiation cystitis
- Late signs and symptoms
- Acute radiation injury
- Late GI toxicity
- Acute vaginal mucositis
- Vaginal ulceration or necrosis
- Vaginal stenosis
- BONE AND BONE MARROW