Vol. 1, Issue 10, Part K (2015)

Abstract
Radiotherapy (RT) is a key modality in treating carcinoma of cervix in all stages. Overall survival rates for patients with stage I and IIA cervical cancer treated with surgery or radiation usually range between 60% to 90%, suggesting that the two treatment modalities are equally effective. As with other modalities, the high cure rates with radiation therapy comes with some amount of complications. For patients with similar tumors, the overall rate of major complications is similar with surgery and radiotherapy, although urinary tract complications tend to be more common after surgical treatment (6-20%) and bowel complications (1-13%) are more common after radiotherapy. Complication rates tend to be higher when irradiation is combined with surgery. The chief complications noted after combined modality treatment are leg edema in approximately 15% cases, dysuria in 8% and positive urine culture in 20% cases. The dose of irradiation, technique, and the type of surgical procedure performed are important in determining the morbidity of combined therapy. With RT alone, complications differ with different techniques of radiation therapy and mainly depend on the stage of the disease, general condition of the patient, dose of radiation therapy, field arrangements, abdominal girth, dose rate, volume of irradiated tissue, expertise of the Radiation Oncologist and co-existing disease like inflammatory bowel diseases. Acute gastrointestinal side effects of pelvic irradiation are seen in about 41% and include diarrhea, abdominal cramping, rectal discomfort, & occasionally rectal bleeding, which may be caused by transient enteroproctitis. Genitourinary symptoms, secondary to cystourethritis, are dysuria, frequency, and nocturia. Erythema and dry or moist desquamation may develop in the perineum or intergluteal fold. The incidence of major late sequelae of radiation therapy for stage I and IIA carcinoma of the cervix ranges from 3% to 5%, and for stage IIB and III, between 10% and 15%. Five-year actuarial incidence of overall (all grades) and severe (grade 3/4) late toxicities in the rectum, bladder, small intestine and subcutaneous tissue may be as high as 12.3% and 1.1%, 11.2% and 1.2%, 9.2% and 0.2%, and 23.1% and 1.2%, respectively. Vaginal adhesions are seen in approximately 30% of cases and stenosis in one third of patients. With newer modalities like proton therapy, hadron therapy and inclusion of modern technological advancements in the radiation therapy planning, finding a cure for carcinoma of cervix with minimal complications is not too distant.