Treatment of recurrent pelvic and selected primary gynecologic malignancies with 241Am

Optimizing Palliative Pelvic Radiotherapy in Gynecological Cancers: A Systematic Review and Analysis

BACKGROUND

Palliative radiotherapy plays a crucial role in managing symptomatic gynecological cancers (GCs). This article aims to systematically review literature studies on palliative pelvic radiotherapy in cervical, endometrial, ovarian, vaginal, and vulvar cancers. The primary focus is centered around evaluating symptom relief, quality of life (QOL), and toxicity in order to ascertain optimal radiotherapy regimens.

METHODOLOGY

For this thorough review, we mainly relied on Medline to gather papers published until November 2023. Selected studies specifically detailed symptomatology and QOL responses in palliative pelvic radiotherapy used for GCs.

RESULTS

Thirty-one studies, mostly retrospective studies and those lacking standardized outcome measures, showed varied responses. Encouraging outcomes were noted in managing hemorrhage (55%) and pain control (70%). However, comprehensively assessing overall symptom response rates and toxicity remained challenging. Investigations into 10 Gy fractionation revealed benefits in addressing tumor-related bleeding and pain in female genital tract cancers.

CONCLUSIONS

Palliative pelvic radiotherapy effectively manages symptomatic GCs. Nonetheless, unresolved dosing and fractionation considerations warrant further investigation. Embracing modern therapies alongside radiotherapy offers improved symptom control, emphasizing the importance of selecting suitable patients for successful GC palliation interventions.

Re-irradiation in Gynaecological Malignancies: A Review

Re-irradiation in gynaecological malignancies has become an increasingly frequent consideration. This can be delivered in multiple settings, with the most common being a patient with a history of cervical cancer developing a new vaginal cancer or endometrial cancer with local recurrence after hysterectomy and adjuvant pelvic radiation. A systematic review of the literature has unearthed a handful of reports, most delivering brachytherapy, with a small number on both external beam radiotherapy and stereotactic ablative radiotherapy. A detailed review of these papers suggests that it is not possible to draw any firm conclusions or put forward guidelines for this challenging area of gynaecological oncology. Here the author has provided a brief account of each paper, followed by a discussion of the literature, aiming to outline some very broad principles for management. It is recommended that such patients be referred to centres that treat high volumes of gynaecological malignancies, as the experience of the treating oncologist may be the most important factor in the management of these patients.

Chemoradiation as primary or adjuvant treatment for locally advanced carcinoma of the vulva

PURPOSE

To determine the impact of primary or adjuvant chemotherapy and radiation (CRT) on the survival rates of patients with locally advanced vulvar carcinoma.

METHODS AND MATERIALS

Between 1973 and 1998, 54 patients with vulvar cancer were treated with radiation therapy, among which 20 received CRT, while 34 patients received radiation therapy (RT) alone. Of the 20 patients, 14 were treated for primary or recurrent disease (pCRT), and 6 after radical vulvectomy for high-risk disease (aCRT). Of the 34 patients, 12 were treated primarily (pRT) and 22 received adjuvant treatment (aRT). Chemotherapy consisted of 2 courses of 5-fluorouracil (5-FU) and mitomycin C administered during RT. Six patients received cisplatin in place of mitomycin C. In CRT groups, radiation was administered to the vulva, pelvic, and inguinal lymph nodes to a median dose of 45 Gy with additional 6-17 Gy to gross disease. In RT groups, the median dose to the microscopic diseases was 45 Gy. Nine patients received external beam boost and 16 patients received supplementary brachytherapy in the forms of (226)Ra or (241)Am plaques to sites of macroscopic disease.

RESULTS

Overall survival was superior in the patients treated with pCRT versus pRT with statistical significance (p = 0.04). There was also a statistically significant improvement in disease-specific (p = 0.03) and relapse-free survival (p = 0.01) favoring pCRT. No statistically significant trends of improved survival rates favoring aCRT over aRT were observed.

CONCLUSION

Concurrent radiation therapy and chemotherapy decreases local relapse rate, improves disease-specific and overall survival over RT alone as primary treatment for locally advanced vulvar cancer.