Radiation Therapy for Endometrial Cancer

Doctors at NYU Langone may use radiation therapy to treat women who have endometrial cancer that has spread beyond the uterus and those who are at risk of a recurrence. Radiation therapy is a treatment that uses high-energy beams or materials to destroy cancer cells.

Radiation therapy is often used after surgery to destroy any remaining cancer cells and to prevent a recurrence. This therapy is also the main treatment for women with recurrent uterine cancer and for those who cannot have surgery due to health concerns.

Our doctors may combine radiation therapy and chemotherapy—drugs that destroy cancer cells—to eliminate large tumors in the uterus or cancer that has spread to other areas of the body. This type of treatment is called chemoradiation.

Treatment Planning

Our radiation oncologists use CT scans and computer software to create a three-dimensional image of the tumor and surrounding organs. This allows your doctor to develop a customized treatment plan that targets the tumor and spares healthy tissue, enhancing the treatment’s effectiveness and reducing side effects.

Your doctor may order frequent CT scans during treatment to ensure that radiation therapy avoids nearby healthy organs and tissues. This also allows the doctor to track the size and shape of the tumor as it shrinks. In addition, targeted therapy helps to prevent radiation from reaching the ovaries, preserving fertility in women who have not reached menopause.

Doctors determine the type of radiation therapy based on the tumor’s size, location, and risk of spreading.

External Beam Radiation Therapy

External beam radiation therapy delivers radiation to the pelvis from a machine outside the body called a linear accelerator. External beam radiation therapy is often used to eliminate cancer cells that may remain in the pelvis after surgery.

During this treatment, you lie down on a table while the machine rotates around you, delivering radiation from different directions for approximately 15 to 20 minutes.

NYU Langone doctors use the following types of external beam radiation therapy for women with endometrial cancer.

Three-Dimensional Conformal Radiation Therapy

In three-dimensional conformal radiation therapy, the radiation dose is based on the tumor’s height, length, and depth. Treatment is delivered once a day, five days a week, over the course of several weeks.

Dividing the radiation into smaller doses called fractions reduces the risk of radiation exposure to nearby tissue, thereby decreasing the chance of side effects.

Intensity Modulated Radiation Therapy

Intensity modulated radiation therapy divides the radiation into “minibeams,” or many small, computer-controlled doses of different strengths. With intensity modulated radiation therapy, the doctor can tailor the radiation dose to the size, shape, and location of the tumor. This technique also prevents radiation from affecting healthy tissue in the intestines and bladder.

Intensity modulated radiation therapy is performed once a day, five days a week, over the course of several weeks.

Volumetric Modulated Arc Radiation Therapy

This type of therapy allows the linear accelerator to move around you in one or several 360-degree rotations during each treatment. This means radiation can be given from almost any angle, allowing doctors to target the tumor while avoiding healthy tissue. Physicians are also able to adjust the angle and intensity of the radiation beams without stopping treatment.

Because this radiation therapy is given without interruption, treatment sessions may be shorter than with other types of external beam radiation therapy. Sessions are given once daily, five days a week, over the course of several weeks.

Stereotactic Body Radiation Therapy

Stereotactic body radiation therapy delivers a few high doses of carefully targeted radiation beams. This occurs several days a week for a few weeks.

Your doctor may use this approach to treat small endometrial tumors if you are older or too ill to have surgery. Our doctors may also recommend stereotactic body radiation therapy if other types of external beam therapy do not eliminate the cancer.

As with other forms of radiation therapy at NYU Langone, this approach uses computer and image guidance to precisely target the tumor while avoiding healthy tissue.

High Dose Rate Brachytherapy

High dose rate brachytherapy may be used after surgery to kill remaining cancer cells and reduce the risk of recurrence. In this approach, doctors temporarily place a radioactive substance directly on the area where the cancer occurred or in the area where cancer may return. Endometrial cancer often recurs in the “vaginal cuff,” the area in the vagina where the surgeon typically makes an incision during a hysterectomy.

For women who have small tumors with a low risk of spreading, our doctors may use brachytherapy alone. For women with larger or recurrent endometrial cancer, brachytherapy may be combined with external beam radiation therapy to the pelvis and lymph nodes.

Intravaginal Brachytherapy

During intravaginal brachytherapy, the doctor places an applicator in the vagina. The applicator delivers radioactive material to the vaginal cuff and is removed after about 10 minutes.

This method reduces the risk of radiation to nearby structures, such as the bladder and rectum.

Intravaginal brachytherapy treatments are given weekly for three weeks. Our doctors may use a local anesthetic to ensure your comfort during the procedure.

Interstitial Brachytherapy

Interstitial brachytherapy involves placing radiation directly in or near the tumor. This method may be used if the cancer has spread to an area of the pelvis that isn’t accessible with the intravaginal approach.

During interstitial brachytherapy, the doctor delivers radiation with a needle or a catheter, which is a thin, hollow tube inserted through the vagina. Interstitial brachytherapy is performed using epidural anesthesia, which blocks pain below the waist, or general anesthesia.

Our doctors may use interstitial brachytherapy for several minutes at a time over the course of a few days or weeks. It may be given on an outpatient or inpatient basis.

Managing Side Effects

The vast majority of women complete radiation therapy for uterine cancer without significant difficulty. However, side effects and potential complications of radiation therapy can occur. They are typically limited to the areas of the body targeted by radiation therapy.

External beam radiation therapy to the abdominal or pelvic area may cause diarrhea, abdominal cramping with nausea, or increased frequency of bowel movements or urination. Radiation can also reduce the production of blood cells, which can make you feel tired. These symptoms are usually temporary and resolve after the completion of treatment.

After being treated with external beam radiation therapy, some women experience complications, such as bowel obstruction, ulcers, or lymphedema. Lymphedema is a swelling in the lower part of the body caused by a buildup of lymph fluid that occurs after lymph nodes have been removed or affected by radiation therapy.

Brachytherapy can affect the vagina in several ways, although side effects are typically infrequent. Side effects may include vaginal dryness, urinary tract infections, and the development of vaginal scar tissue, which can make vaginal intercourse painful. Our doctors recommend stretching the walls of the vagina, either through sexual intercourse or by inserting a plastic or rubber tube to dilate the vagina, several times a week to prevent this scarring.

NYU Langone radiation oncologists aim to reduce the risk of side effects. If you experience side effects of treatment, inform your doctors, who can almost always help you to effectively manage them. NYU Langone also offers supportive and integrative services that may help.

Although our radiation oncologists use targeted treatments, radiation can damage the ovaries, triggering early menopause. Most women treated for endometrial cancer have already gone through menopause, either naturally or as a result of surgery to treat the cancer. If you have been diagnosed with endometrial cancer and have not yet reached menopause, our gynecologic oncologists and fertility experts can discuss options for preserving your fertility.

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