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Radiotherapy to the female pelvis

Radiotherapy to the female pelvis. Dr Sherif Raouf MB BCh FRCR Consultant Clinical Oncologist BHRUT. How does radiotherapy works?. Mechanism of action: radiation induce damage of tumour cell DNA, preventing cell division and causing cell death. Radiotherapy uses. Curative indications:

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Radiotherapy to the female pelvis

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  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: 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. 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

  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.

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