This page discusses the use of radiation therapy for the treatment of cervical cancer. For a thorough review of radiation therapy for cancer treatment, please see the ]]>radiation therapy treatment monograph]]> .

Radiation therapy is the use of penetrating beams of high-energy waves or streams of particles called radiation to treat disease. Radiation therapy destroys the ability of cancer cells to grow and divide.

Radiation therapy is a primary treatment option for cervical cancer. It is often used concurrently with ]]>chemotherapy]]> . In early-stage disease, it is a notable alternative to ]]>radical surgery]]> . It is also often used after surgery to help prevent or minimize recurrences of cancer.

Advantages of radiation therapy are that it can usually be given on an outpatient basis, with intraoperative and postoperative complications avoided. In addition, the time to receive each treatment is very short. As with other cancer treatments, though, its adverse effects on normal tissues are often long-term.

The Use of Radiation Therapy by Stage of Cancer

Radiation therapy is used in the following cervical cancer stages:

Stage IA:

  • Internal radiation therapy (for women who are not surgical candidates)

Stage IB:

  • Combination of internal radiation therapy and external radiation therapy
  • Radiation therapy plus chemotherapy
  • Radical hysterectomy followed by radiation therapy plus chemotherapy

Stage IIA:

  • Combination of internal radiation therapy and external radiation therapy
  • Radical hysterectomy followed by radiation therapy plus chemotherapy (when a patient is known to have stage 2a disease, they should not go to surgery; patients who have surgery first are those who are not thought to have this stage of disease).
  • Radiation therapy plus chemotherapy

Stage IIB:

  • Internal and external radiation therapy combined with chemotherapy

Stage III:

  • Internal and external radiation therapy combined with chemotherapy

Stage IVA:

  • Internal and external radiation therapy combined with chemotherapy

Stage IVB:

  • Radiation therapy as palliative therapy to relieve symptoms

Types of Radiotherapy Used for Cervical Cancer

Radiation therapy is administered in two forms:

  • External beam whole pelvic radiation
  • Intracavitary tandem and ovoid brachytherapy using radioactive cesium or iridium

For external radiation therapy, rays are directed at the tumor from outside the body. External beam whole pelvic radiation is generally given in divided doses for four to five weeks on an outpatient basis. Most centers administer radiation in single doses of 180 to 200 centigray (cGy) each weekday, until an accumulative dose of 4500 to 5000 cGy to the pelvis is administered.

Tandem and ovoid brachytherapy is a means to deliver high-dose radiation directly to the tumor. Most applicators are placed in the vagina under anesthesia. The cervix is dilated, and a hollow tube is placed in the endocervical canal and into the body of the uterus. Two small, hollow, round applicators are placed external to the cervix, to sit in the vagina on either side of the exocervix. The bladder and rectum are packed away from the applicators using gauze. Typically, 4000 to 8000 additional cGy can be given to the cervix by transvaginal application.

Effectiveness of Radiation Therapy

Radiation therapy has been used with great success in early-stage cervical cancer. Five-year cure rates for women with stage IB or IIA with radiation therapy are 85% to 90%. Stages IIB, III, and IVA are best treated with radiation therapy combined with chemotherapy. The 5-year survival rate for stage IIB is 60% to 65%. The 5-year survival rates for stage III ranges from 25% to 40%. For stage IV, 5-year survival rates are in the 15% to 20% range.

Side Effects and Possible Complications

Radiation therapy may cause the following adverse effects:

  • Diarrhea – commonly occurs when the pelvis area is irradiated, usually two to three weeks into treatment and may last throughout the course of treatment.
  • Cystitis – this is inflammation of the bladder. It commonly occurs if the bladder is within treatment field when the pelvis area is irradiated. Medications can be given to help treat this infection.
  • Vaginal stenosis – this is narrowing of the vagina by scar tissue. It can be minimized or treated with a vaginal dilator, which is inserted into the vagina, withdrawn, and reinserted for a period of five to 10 minutes. It is suggested that vaginal dilation be performed three times a week for the rest of a women’s life.
  • Ovarian failure – this produces symptoms of menopause, such as hot flashes, decreased libido, cessation of menstrual periods (amenorrhea), and osteoporosis. Older women are at higher risk for this complication than younger women.

When to Contact Your Health Care Provider

Call your doctor if you experience any of the following:

  • A pain that doesn't go away, especially if it's always in the same place
  • New or unusual lumps, bumps, or swelling
  • Nausea, vomiting, diarrhea, or loss of appetite
  • Unexplained weight loss
  • A fever or cough that doesn't go away
  • Unusual rashes, bruises, or bleeding
  • Any symptoms that you are concerned about

For more information on radiation therapy, including how to manage the side effects, please see the ]]>radiation therapy treatment monograph.]]>