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

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

3. 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

4. Radiotherapy planning
Procedure for giving radiotherapy
Diagnosis
Radiotherapy planning
Treatment delivery

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

6. Positioning lasers 6

7. 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 …..

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

9. Skin desquamation

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

11. 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.

12. Skin telangectasia

13. Vaginal dilators

14. Sparing normal tissues is not an easy task

15. Intensity modulated radiotherapy (IMRT)

16. Using multiple fields allows for better sparing of normal tissues

17. 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.