Impact of Newer RT Modalities in management of Gynecological cancers
Gynecologic cancers were among the first malignancies to be treated with ionizing radiation, more than a century ago. Radiation therapy is an essential component of the primary nonsurgical management and also adjuvant postoperative treatment of gynecological malignancies. They may be delivered using external beam radiation therapy (EBRT) techniques or internally with intracavitary or interstitial techniques, or as usually practiced, usually a combination of these. Radiation earlier, was planned by 2D or conventional technique, where doses of radiotherapy were given to large areas of the target area without protecting the normal areas around, producing many acute and chronic toxicities.Advances in MRI are impacting diagnosis, radiation target delineation, planning, treatment delivery, and response assessment. The combination of MRI and PET-computed tomography (PET-CT) has the potential to significantly change treatment recommendations as compared with a single imaging modality.
Recent technological developments with intensity-modulated radiation therapy (IMRT) Image Guided radiotherapy (IGRT) and volumetric modulated arc therapy (VMAT) help to offer greater precision to the target volume and simultaneously aims to reduce the radiation dose to organs at risk (OAR). Similar technical developments have also been implemented in brachytherapy too, where image guided adapted brachytherapy (IGABT) has helped to improve the quality of radiation and the outcome.
Selected patients with para-aortic or local relapse but with no other site of disease should be considered for curative intent treatment as a number of them may enter long-term remission. Perhaps most exciting of all has been the use of stereotactic ablative radiation techniques (SABR) for locally recurrent disease. This uses very precise targeted radiation using IMRT- techniques to deliver high dose, ultra-localised radiation to the sites of relapse, usually using large-fraction and short-duration treatments. This is well tolerated even in situations of reirradiation and the initial reports suggest that some long-term remission may be achieved.
As imaging and radiation technologies advance, the indications for radiation in the treatment of gynecologic malignancies will continue to evolve. RT remains an indispensable technique in the management and control of most of the gynecological cancers. Recent developments have improved the local control and overall outcome of almost all gynecological carcinomas.