Medical experts talk about popular science | Go away, tumor - "magic hands" radiotherapy allows patients with localized advanced cervical cancer to regain new life

Cervical cancer is the second most common malignant tumor among women in my country.

Most patients are diagnosed in the local middle and late stages. In fact, surgical resection is not the only treatment method. According to the recommendation of the National Comprehensive Cancer Network (NCCN), surgical resection is only recommended for very early cervical cancer. For the vast majority of patients who have reached the local middle and late stages when they seek medical treatment, the standard treatment model is radical radiotherapy combined with synchronous chemotherapy. Clinically, if the tumor diameter exceeds 4 cm, radical synchronous radiotherapy and chemotherapy are recommended instead of surgical treatment. Even for very early cervical cancer, the therapeutic effects of radiotherapy and surgery are equivalent. Most people are unfamiliar with radiotherapy, and even very afraid of it. They think it is a very terrible treatment method. Many friends think that after radiotherapy, the skin is "burned", the organs are "burned", and the body is "radiated" and it will affect the health of the family, etc., thereby delaying the disease and losing the best time for treatment. In fact, these worries are unnecessary. With the deepening of medical understanding of tumors and the continuous advancement of radiotherapy technology, radiotherapy has entered an era of precision, even reaching the millimeter level. Therefore, it can effectively kill tumor tissue while having very little impact on normal tissue. If the patient has certain adverse reactions during radiotherapy, such as malignancy, vomiting, etc., active symptomatic supportive treatment is sufficient to alleviate the symptoms and successfully complete the entire treatment process.

l What is radiotherapy? What are the common radiotherapy equipment in clinical practice?

Radiotherapy (abbreviated as radiotherapy) refers to physical therapy that uses X-rays, gamma rays, electron beams and other radiation to treat malignant tumors and some benign tumors. The advantages of radiotherapy are to preserve the structure and function of tissues and organs to the greatest extent; improve the quality of life of patients; and improve the survival rate of patients with various solid tumors.

Common radiotherapy equipment in clinical practice includes linear accelerators and afterloaders. Linear accelerators can generate high-energy X-rays and electron beams, which enter the patient's body from outside the body to kill the tumor, so it is called external irradiation. The working principle of the afterloader is to insert the applicator into the natural cavity of the human body, and the radioactive source enters the applicator to reach the inside or near the tumor to achieve the purpose of treating the tumor, so it is also called close-range therapy. The female uterine cavity is a natural cavity of the human body, so close-range therapy has a natural advantage in the radiotherapy of cervical cancer.

l What kind of cervical cancer patients are suitable for radiotherapy?

Early-stage disease (stages IA, IB1, IB2, IIA1):

Generally speaking, patients with tumors smaller than 4 cm and without pelvic/retroperitoneal lymph node metastasis can undergo surgical resection. Postoperative radiotherapy is determined based on the pathological condition. For patients with pelvic lymph node metastasis, positive resection margins, and paracervical invasion, conventional postoperative radiotherapy is performed.

Patients with advanced stage (stage IB3, IIA, IIB, III, IVA):

Patients with tumors larger than 4 cm, parametrial invasion, pelvic wall involvement, pelvic/retroperitoneal lymph node metastasis, and rectal or bladder invasion should undergo radical radiotherapy, concurrent chemotherapy, and subsequent brachytherapy.

Patients with relapse/metastasis

Palliative treatment can be given to patients with recurrence/metastasis, such as radiotherapy for pain relief in the case of bone pain and stereotactic radiotherapy for intracranial metastasis.

l What is the process and precautions of radiotherapy for local advanced cervical cancer?

For patients with cervical cancer who are receiving initial treatment, CT simulation positioning should be performed first, the target area should be outlined, a treatment plan should be developed, and the position and dose should be verified. Then external radiation therapy should be started, and platinum chemotherapy drugs should be given during radiotherapy to enhance sensitization. After external radiation, intracavitary or interstitial brachytherapy should be performed according to the degree of tumor regression. For difficult cases with large tumors or recurrence after radiotherapy, interstitial implantation therapy based on 3D printed applicator technology can be performed.

During radiotherapy, patients may experience symptoms such as fatigue, nausea, and vomiting. Therefore, they need to get proper rest, maintain a good attitude, strengthen nutrition, and avoid irritating foods. In addition, they should insist on vaginal douching to prevent vaginal infection and adhesion. After nausea and vomiting, they should be given symptomatic supportive treatment such as antiemetics and fluid replacement.

External radiotherapy for cervical cancer

1. Accurate positioning

2. Precise planning

3. Precision treatment

Application of 3D printed interstitial implant technology in complex and refractory (pelvic wall involvement, recurrence) cervical cancer

l How is the effect of radiotherapy for localized advanced cervical cancer? What are the precautions after treatment?

With the advancement of radiotherapy technology, the treatment effect of localized advanced cervical cancer is getting better and better. The overall survival rate of five years can reach more than 70%. After the treatment, patients need regular follow-up and reexamination. Generally, they should be examined every 3 to 6 months in the first two years, and every six months to one year after two years. In addition to regular reexamination, it is recommended to perform vaginal dilation and vaginal washing to prevent adhesions; develop good living habits: quit smoking, exercise properly, eat a reasonable diet, etc.

Author | Wang Tiejun

Director of the Radiotherapy Department of the Second Hospital of Jilin University, chief physician, professor, doctoral supervisor, and national expert. His current academic positions include member of the Chinese Medical Association Radiation Oncology Branch, member of the Chinese Medical Association Radiation Medicine and Protection Branch Committee, deputy leader of the Gynecological Tumor Radiotherapy Group of the Chinese Medical Association Radiotherapy Physician Branch, member of the Chinese Medical Association Brachytherapy Group, and chairman of the Tumor Radiotherapy Professional Committee of the Jilin Anti-Cancer Association. He participated in the formulation of three domestic malignant tumor brachytherapy and gynecological tumor intracavitary radiotherapy standards and the compilation of the national treatment standards for intraoperative radiotherapy of rectal cancer, and his academic status has reached the national level.

| Discipline Introduction

The Department of Radiotherapy of the Second Hospital of Jilin University is composed of several sub-specialty groups, including the head and neck group, chest group, abdomen group, gynecological tumor group and minimally invasive treatment group. As the birthplace of radiotherapy in Jilin Province, it is the continuing medical education and training base for tumor radiotherapy in Jilin Province, the demonstration unit for standardized diagnosis and treatment of cancer pain in Jilin Province, the chairman unit of the Tumor Radiotherapy Branch of the Jilin Anti-Cancer Association, the chairman unit of the first Changchun Medical Association Radiotherapy Branch, the chairman unit of the Oncology Specialty of the Changchun Medical Association, the key discipline of tumor radiotherapy in Changchun, and the leader unit of the Jilin Province in the field of tumor radiotherapy evaluation of health talents of the National Health and Family Planning Commission. The department is equipped with domestically advanced medical equipment and precise quality control verification equipment. The hospital is the first in the province to carry out projects such as image-guided three-dimensional conformal intensity modulated radiotherapy, stereotactic radiotherapy, three-dimensional conformal brachytherapy, thermal perfusion chemotherapy, particle implantation, microwave thermal therapy, radiofrequency ablation, intraoperative radiotherapy, and brachytherapy with interstitial implantation using 3D printing technology, achieving comprehensive treatment of cross-disciplinary tumors, especially the interstitial implantation treatment technology for cervical cancer has reached the international advanced and domestic leading treatment level, and has held three consecutive "National CT-guided Interstitial Implantation Brachytherapy for Cervical Cancer Special Training Courses", which have been widely recognized by peers. At present, it has become a diversified tumor treatment department with outstanding characteristics.