Modern Techniques for Cervical Cancer Radiotherapy

Cervical cancer is a socially significant illness often impacting women of reproductive and working age. The patients’ young age and social activity warrant the development of effective and safe therapies.The past decades have witnessed the novel radiation techniques to contain cervical cancer: 3DCRT-3D, IMRT, and VMAT, adaptive radiotherapy, CT/MRI-guided intracavitary radiation, combined interstitial and intracavitary radiation, abandoning intracavitary intervention for external beam delivery with sequential or concurrent cervical dose escalation, under brachytherapy unfeasible.Modern equipment and treatment planning systems allow a high dose delivery to the tumour and intracavitary treatment with visual control of the target and organs at risk. Combining of intracavitary and interstitial radiotherapy enables a better dose coverage of the target at a minimal radiation impact on organs at risk.Phasing-out of intracavitary for external radiotherapy may enable a cancericide dose delivery to the tumour under intractable intracavitary treatment.The major goal of technic novelties is the establishment of personalised radiotherapy for improving treatment outcomes and reducing the incidence and/or severity of radiation side effects. The article overviews the radiotherapy techniques for cervical cancer treatment and routes of their development.

Interstitial radiotherapy using phosphorus-32 for giant posterior fossa cystic craniopharyngiomas

OBJECT The treatment for giant posterior fossa cystic craniopharyngiomas remains an important challenge in neurosurgery. The authors evaluated the effects of treating 20 patients with giant posterior fossa cystic craniopharyngiomas using phosphorus-32 (P-32) interstitial radiotherapy at their hospital. METHODS The patients included 11 boys and 9 girls with an age range of 3 to 168 months. Before treatment, the tumor volumes ranged from 65 to 215 ml. The intracranial pressure was increased in 16 patients, and optic nerve damage had occurred in 18. The patients received P-32 interstitial radiotherapy following stereotactic cyst-fluid aspiration or drainage and were followed up for 7–138 months. RESULTS The treatment immediately relieved the intracranial hypertension symptoms in all patients. At the end of follow-up, imaging examinations revealed that the cystic tumors had disappeared, but some residual calcification remained in 12 patients, and had decreased by more than 75% of the initial volume in 8 patients. The damaged optic nerve recovered in 3 cases, improved in 12 cases, remained unchanged in 1 case, and was aggravated in 2 cases. No other severe complications related to surgery or interstitial radiation occurred. During the follow-up period, 7 new cysts appeared in 5 patients who had received additional interstitial radiotherapies with a dose of P-32 that was calculated using the same formula as for the initial treatment. The new tumors then disappeared in 2 patients, significantly shrank in 2 patients, and progressed in 1 patient. CONCLUSIONS For treating giant posterior fossa cystic craniopharyngiomas, P-32 interstitial radiation after stereotactic cyst-fluid aspiration or drainage can achieve a high tumor control rate and has relatively satisfactory clinical effects and quality of life outcomes with few complications.

The evolution of treatment for hypothalamic hamartoma: a personal odyssey

The prognosis for patients with hypothalamic hamartoma has improved dramatically over the last 20 years, for 3 main reasons. First, because of improved understanding of the anatomy and pathophysiology of these varied lesions. Second, due to advances in brain imaging and refinements in microsurgery, including the anterior transcallosal interforniceal approach, endoscopic, and skull-base approaches. And third, because of increasing experience with stereotactic radiosurgery, interstitial radiotherapy, and radiofrequency lesioning. Patients with hypothalamic hamartoma should be managed in comprehensive epilepsy centers where the treatments are individualized and concentrated in the hands of surgeons who can perform the full range of surgery, including approaches to the third ventricle. Total seizure-freedom rates of 52% to 66% have been achieved with surgery.