Endometrial and cervical cancers remain very prevalent in our society. Endometrial cancer refers to several types of malignancies that develop in the cells that form the inner lining of the uterus (endometrium), and is one of the most common cancers of the female reproductive system.
This cancer occurs most frequently in women aged 60 years or older and is on a slow rise, worldwide, due to the increase in the aging population. In Western Europe, about 70 % of endometrial cancers are diagnosed at an early stage, and as a result the majority of patients are cancer free following the treatment.
Cervical cancer is most commonly found in women age 30 – 50 years. Over the past decades, the incidence of cervical cancer has decreased greatly in countries where routine gynecological examinations, PAP tests and vaccines are readily available. Still, cervical cancer remains the number one cause of female cancer mortality worldwide.
Developing countries have much higher rates of cervical cancer and, worldwide, there are three times as many cases of cervical cancer as endometrial cancers diagnosed each year. Cancer can also be found in other parts of the female reproductive system, such as the ovaries, vagina and vulva. However, these are more rare types.
As for all cancers, the long-term prognosis depends on the stage of the cancer. With treatment, almost all patients will survive the earliest stages of invasive cervical cancer.
The treatment of cervical cancer depends on the spread of the malignant tumor. The tumor can be removed by surgery and in some cases, it may be necessary to add a radiation and/or chemotherapy. For some patients a surgery may not be the first choice of treatment and is replaced a radiation or chemotherapy.
There are many treatment choices for gynecological cancers. For both endometrial and cervical cancers, the use of HDR brachytherapy has been shown to be very effective.
Necessarily, there is a variety of gynecological HDR applicators existing. Different designs allow to adopt to the patient´s anatomy as well as the characteristics of the tumor.
The high activity radioactive source is positioned in close proximity to the tumor (intracavitary brachytherapy) or within the tumor itself (interstitial brachytherapy), allowing each treatment session to be completed in one to two hours. An important benefit of HDR brachytherapy is that the position of the radiation can be precisely calculated and adjusted, allowing customized dose distributions based on the individual patient’s tumor and anatomy.
For endometrial and cervical cancer, HDR brachytherapy is delivered using special intra-vaginal applicators for introduction of the radioactive source. Once the treatment is done, the applicator is removed and the patient can continue her day. Patients with cervical cancer will require a few short treatments given over a couple of days.
For vaginal cancer, a cylinder similar to a plastic tampon with a central channel is used. After placement of the cylinder, it is connected to the HDR afterloader where the radioactive source is stored until the time of treatment. After the treatment is complete, the vaginal cylinder is disconnected and removed from the patient. The treatment takes about an hour and most patients will require only a few treatment sessions. After the treatment is complete, the patient can continue with her day as this type of treatment is extremely well tolerated.
The benefits of HDR brachytherapy in the treatment of gynecological cancers are: