Medical Radiology and Radiation Safety. 2024. Vol. 69. № 5
DOI:10.33266/1024-6177-2024-69-5-104-108
P.A. Lushnikova1, 2, Ya.N. Sutygina1, 2, E.S. Sukhikh2, 3, Zh.A. Startseva3,
A.A. Polyakov1
Possibilities of Modern Radiation Therapy for Locally Advanced Endometrial Cancer
1 Tomsk Regional Oncology Center, Tomsk, Russia
2 National Research Tomsk Polytechnic University, Tomsk, Russia
3 Tomsk National Research Medical Center, Tomsk, Russia
Contact person: P.A. Lushnikova, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
ABSTRACT
Purpose: Analysis of radical radiotherapy efficacy (combination of remote irradiation with simultaneous dose escalation to the tumor focus and subsequent intracavitary component) in a patient diagnosed with stage III endometrial cancer when surgical treatment is impossible. Assessment of the dynamics of the underlying disease and adverse events. The purpose of the study is to analyze the effectiveness of radical radiation therapy in a patient diagnosed with stage III endometrial cancer when surgical treatment is impossible.
Material and methods: We present a clinical case of a patient with inoperable stage III endometrial cancer (histologic variant-highly differentiated adenocarcinoma) with metastasis to the lower third of the vagina. The first stage was a course of remote radiotherapy on a linear gas pedal VarianTrueBeamSTx on the uterus, vagina, paravaginal tissues, pelvic lymph nodes up to a total dose of 50 Gy and simultaneous dose intensification on the area of tumor focus in the lower third of the vagina up to a total dose of 62.5 Gy. The method of dose administration was rotational radiotherapy with intensity modulation of photon radiation (Volume-modulated arc therapy ‒ VMAT).
The second stage was a course of intracavitary (contact, brachytherapy) radiotherapy on MultiSource HDR device with 60Co ionizing radiation source. A gynecological two-channel applicator was used during treatment. The plan of each treatment session was developed based on CT images on the SagiPlan planning station. Intracavitary radiation therapy mode – single dose of 6 Gy, 4 fractions were performed.
The effect of radiation therapy was assessed by MRI of pelvic organs with intravenous contrasting immediately after treatment and further at intervals of every 3 months.We present a clinical case of a 71 year old female patient diagnosed with stage III endometrial cancer (well-differentiated adenocarcinoma), with adenocarcinoma metastasis to the lower 1/3 of the vagina. Planning of radiotherapy and radiation therapy in a patient with inoperable endometrial cancer with simultaneous escalation of the dose of ionizing radiation to the area of metastasis in the vagina during the remote component and subsequent intracavitary boost to the uterine area. Study of the results of radiation therapy.
Results: After treatment, MRI data showed complete regression of the tumor nidus in the vagina and reduction of the nidus in the uterine body (more 50 %). Long-term control of the tumor process in the patient, confirmed by clinical and radiological studies (MRI of the pelvic organs), was also achieved.The capabilities of modern radiation therapy make it possible to carry out radical treatment of patients with endometrial cancer in clinical cases when it is necessary to increase the dose of ionizing radiation to a separate tumor focus, without exceeding the tolerable levels of radiation exposure to risk organs. This approach makes it possible to achieve remission in real clinical practice.
Conclusion: The capabilities of modern radiation therapy allow radical treatment of patients with inoperable endometrial cancer in clinical cases when it is necessary to increase the dose of ionizing radiation to a separate tumor focus without exceeding tolerance levels of radiation loads on risk organs. This approach makes it possible to achieve remission in real clinical practice.
Keywords: endometrial cancer, radiation therapy, dose escalation, intensity modulated radiation therapy, dosimetric planning, linear accelerator
For citation: Lushnikova PA, Sutygina YaN, Sukhikh ES, Startseva ZhA, Polyakov AA. Possibilities of Modern Radiation Therapy for Locally Advanced Endometrial Cancer. Medical Radiology and Radiation Safety. 2024;69(5):104–108. (In Russian). DOI:10.33266/1024-6177-2024-69-5-104-108
References
1. Каприн А.Д., Старинский В.В., Шахзадова А.О. Злокачественные новообразования в России в 2021 году (заболеваемость и смертность). М., 2022. C.4-12. [Kaprin A.D., Starinsky V.V., Shakhzadova A.O. Zlokachestvennyye Novoobrazovaniya v Rossii v 2021 godu (Zabolevayemost’ i Smertnost’) = Malignant Neoplasms in Russia in 2021 (Morbidity and Mortality). Moscow Publ., 2022. P. 4-12 (In Russ.)].
2. Ашрафян Л.А., Тюляндина А.С., Берлев И.В., Кузнецов В.В., Шевчук А.С., Новикова Е.Г., Урманчеева А.Ф., Вереникина Е.В., Демидова Л.В., Антонова И.Б., Бабаева Н.А., Кравец О.А., Крикунова Л.И., Коломиец Л.А., Крейнина Ю.М., Мухтаруллина С.В., Ульрих Е.А., Хохлова С.В., Нечушкина В.М., Снеговой А.В., Трякин А.А., Герфанова Е.В. Рак тела матки и саркомы матки: Клинические рекомендации. M.: МЗ РФ, 2021. [Ashrafyan L.A., Tyulyandina A.S., Berlev I.V., Kuznetsov V.V., Shevchuk A.S., Novikova E.G., Urmancheeva A.F., Verenikina E.V., Demidova L.V., Antonova I.B., Babaeva N.A., Kravets O.A., Krikunova L.I., Kolomiets L.A., Kreinina Y.M., Mukhtarullina S.V., Ulrich E.A., Khokhlova S.V., Nechushkina V.M., Snegovoy A.V., Tryakin A.A., Gerfanova E.V. Rak Tela Matki i Sarkomy Matki: Klinicheskiye Rekomendatsii = Cancer of the Uterine Body and Uterine Sarcomas. Clinical Recommendations. Ministry of Health of the Russian Federation Publ., 2021 (In Russ.)].
3. Clinical Practice Guidelines in Oncology (NCCN Guidelines) Version 2.2024. March 6. 2024.
4. Wright J.L., Yom S.S., Awan M.J., Dawes S., Fischer-Valuck B., Kudner R., Mailhot Vega R., Rodrigues G. Standardizing Normal Tissue Contouring for Radiation Therapy Treatment Planning: an ASTRO Consensus Paper. Pract Radiat Oncol. 2019 Mar; 9;2:65-72.
5. Chargari C., Peignaux K., Escande A., Renard S., Lafond C., Petit A., Hannoun-Levi J.M., Durdux C., Haie-Meder C. Radiotherapy for Endometrial Cancer. Cancer Radiother. 2022 Feb-Apr; 26;1-2:309-314.
6. Schwarz J.K., Beriwal S., Esthappan J., Erickson B., Feltmate C., Fyles A., Gaffney D., Jones E., Klopp A., Small W. Jr., Thomadsen B., Yashar C., Viswanathan A. Consensus Statement for Brachytherapy for the Treatment of Medically Inoperable Endometrial Cancer. Brachytherapy. 2015 Sep-Oct;14;5:587-99.
7. Supakorn Pitakkarnkul, Saranya Chanpanitkitchot, and Siriwan Tangjitgamol. Management of Inoperable Endometrial Cancer. Obstet Gynecol Sci. 2022 Jul; 65;4:303–316.
8. Хансен Э.К. Лучевая терапия в онкологии / Пер. с англ. М.: ГЭОТАР-Медиа, 2014. 992 с. [Hansen E.K. Luchevaya Terapiya v Onkologii = Radiation Therapy in Oncology. Moscow, GEOTAR-Media Publ., 2014. 992 p. (In Russ.)].
9. eContour. URL: http://econtour.org/cases/3 (accessed date 31.07.2018).
10. American Society for Radiation Oncology (ASTRO). ASTRO Annual Meeting Abstracts. 2019. Retrieved from [insert link here, e.g., https://www.astro.org/]
11. International Commission on Radiation Units and Measurements. (2010). Prescribing, Recording, and Reporting Photon-Beam Intensity-Modulated Radiation Therapy (IMRT). ICRU Report 83. J. ICRU. 10(1).
12. Rovirosa А., Zhang Y., Tanderup K., Ascaso C., Chargari C., Van der Steen-Banasik E., Wojcieszek P., Stankiewicz M., Najjari-Jamal D., Hoskin P., Han K., Segedin B., Potter R., Van Limbergen E. Endometrial Task Group. Stages I-III Inoperable Endometrial Carcinoma: a Retrospective Analysis by the Gynaecological Cancer GEC-ESTRO Working Group of Patients Treated with External Beam Irradiation and 3D-Image Guided Brachytherapy. Cancers (Basel). 2023 Sep 27;15;19:4750.
13. Pгuetter R., Haie-Meder C., van Limbergen E., et al. Recommendations from Gynaecological (GYN) GEC ESTRO Working Group (II): Concepts and Terms in 3D Image-Based Treatment Planning in Cervix Cancer Brachytherapy – 3D Dose Volume Parameters and Aspects of 3D Imagebased Anatomy, Radiation Physics, Radiobiology. Radiother. Oncol. 2006;78:67–77.
PDF (RUS) Full-text article (in Russian)
Conflict of interest. The authors declare no conflict of interest.
Financing. The study had no sponsorship.
Contribution. Article was prepared with equal participation of the authors.
Article received: 20.05.2024. Accepted for publication: 25.06.2024.