By: Dr. Akanksha Anup, Associate Consultant, Radiation Oncology, Narayana RN Tagore Hospital, Kolkata
Navigating the benefits and challenges of radiation therapy in the fight against cervical cancer.
Cervical cancer remains the second most common cancer affecting females in India, posing a significant public health challenge despite advances in screening and treatment. Among the modalities available, radiation therapy plays a pivotal role across various stages of disease progression. As we continue to strive for improved outcomes, understanding the scope, applications, and implications of this treatment becomes vital for both clinicians and patients.
Role of Radiation Therapy in Cervical Cancer
Radiation therapy may be used as part of the main treatment, especially when combined with chemotherapy. This regimen, known as concurrent chemoradiation, enhances the effectiveness of radiation by increasing the sensitivity of cancer cells to it. It is also employed to manage recurrent or metastatic cervical cancer, where its primary aim is to alleviate symptoms and improve quality of life. Additionally, radiation is indicated after surgical intervention in cases where postoperative findings reveal a high risk of recurrence, necessitating further treatment.
External Beam Radiation Therapy (EBRT)
External Beam Radiation Therapy (EBRT) uses X-rays directed at the tumour from outside the body. Though each session is brief, careful positioning and planning are essential. EBRT is often combined with weekly chemotherapy, usually cisplatin, over five weeks, followed by brachytherapy. For those unable to undergo chemo or surgery, EBRT alone may be used. Common short-term side effects include fatigue, nausea, diarrhoea, skin changes, and radiation cystitis. Vaginal pain, menstrual changes, and low blood counts such as anaemia or neutropenia may also occur but usually improve after treatment ends.
Brachytherapy and Its Effects
Brachytherapy delivers radiation directly near the tumour, typically using intracavitary methods like a tandem and ovoid or tandem and ring, and a vaginal tube post-hysterectomy. Short-term side effects include vaginal irritation, discharge, and soreness, often overlapping with EBRT symptoms. Though usually temporary, long-term risks include vaginal stenosis, dryness from early menopause, rectal and urinary complications (such as fistulas and radiation cystitis), bone weakness leading to fractures, and lymphedema from pelvic radiation.
As cervical cancer therapy continues to evolve, radiation therapy remains a cornerstone of effective treatment. However, a clear understanding of its applications, limitations, and side effects is essential for shared decision-making and optimal patient care. Oncologists must maintain open communication with patients about potential adverse effects and provide strategies to manage them proactively.
Earlier, cervical cancer treatment relied mainly on surgery and basic radiation, which lacked precision and led to higher relapse risks. Today, advanced therapies like concurrent chemoradiation, EBRT, and brachytherapy offer more reliable, targeted care. New technologies like liquid-based cytology, molecular testing, AI, and precision medicine enable early detection and personalised treatment. These innovations have increased survival rates & quality of life.