|Side Effects of
Pelvic Radiation for Gynecological Cancers
Note that radiation can be external or internal or HDR. The side effects of radiation are related to: the area treated (which normal organs are in the way, e.g. the bowel, bladder or rectum, see CT picture of organs affected by radiation here) the size of the radiation field or port (the larger the area, the more the side effects) the dose of radiation (the higher the dose, the more side effects) and whether chemotherapy is being given as well (generally more fatigue and diarrhea).
|The side effects usually start to show up after about 8 or 10 treatments and generally start fading away about a week or two after completing radiation, but it can take several months for all the side effects to wear off. As noted in the studies below about 20-40% of the women have mild side effects but only about 1-5% severe. (side effects from treating the abdomen are discussed here; go here for more studies on gyn pelvic side effects, and the scoring system.)|
|The morbidity of
treatment for patients with stage I endometrial cancer: results from a randomized trial
Carien L. Creutzberg International Journal of Radiation Oncology*Biology*Physics, 2001: 51:5 : 1246-1255
The Postoperative Radiation Therapy in Endometrial Carcinoma (PORTEC) trial included patients with endometrial cancer confined to the uterine corpus, either Grade 1 or 2 with more than 50% myometrial invasion, or Grade 2 or 3 with less than 50% myometrial invasion. Surgery consisted of an abdominal hysterectomy and oophorectomy, without lymphadenectomy. After surgery, patients were randomized to receive pelvic RT (46 Gy), or no further treatment. A total of 715 patients were randomized. Treatment complications were graded using the FrenchItalian glossary.
Results: The analysis was done at a median follow-up duration of 60 months. 691 patients were evaluable. Five-year actuarial rates of late complications (Grades 14) were 26% in the RT group and 4% in the control group (p < 0.0001). Most were Grade 1 complications, with 5-year rates of 17% in the RT group and 4% in the control group. All severe (Grade 34) complications were observed in the RT group (3%). Most complications were of the gastrointestinal tract. The symptoms resolved after some years in 50% of the patients. Grade 12 genitourinary complications occurred in 8% of the RT patients, and 4% of the controls. Bone complications occurred in 4 RT patients (1%). Seven patients (2%) discontinued their RT due to acute RT-related symptoms. Patients with acute morbidity had an increased risk of late RT complications (p = 0.001). The 4-field box technique was associated with a lower risk of late complications (p = 0.06).
Conclusion: Pelvic RT increases the morbidity of treatment in Stage I endometrial cancer. In the PORTEC trial, severe complications occurred in 3% of treated patients, and over 20% experienced mild (mostly Grade 1) symptoms. Patients with acute RT-related morbidity had an increased risk of late complications. As pelvic RT in Stage I endometrial carcinoma was shown to significantly reduce the rate of locoregional recurrence, but without a survival benefit, its use in the adjuvant setting requires careful patient selection (treating those at increased risk of relapse), and the use of treatment schemes with the lowest risk of morbidity.
see table below: