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The goal of radiation therapy is to kill cancer cells with high-energy X-rays. Women with cervical cancer treated with radiation often get low-dose chemotherapy at the same time which can make the radiation therapy more effective. This is called radiosensitization or chemoradiation.

Radiation therapy may be offered for the purposes of cure, or for palliative reasons (to control symptoms). Radiation therapy is the primary management modality for locally advanced cervical cancer.

There are 2 ways methods for the delivery of radiation doses and they may be used in combination:

• External-beam Radiation - With external beam radiation, a machine is used to deliver high-powered X-rays that kill cancer cells. Treatments are generally given five days a week for about six to eight weeks on an outpatient basis. The initial appointment may take up to 2 hours to allow for treatment planning (simulation) and placement of markings where the radiation beam is to be directed. After that, each treatment appointment takes about 15 minutes.

Intensity Modulated Radiation Therapy (IMRT) is a high-precision mode of radiotherapy that utilizes computer-controlled X-ray accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor. The radiation dose is designed to conform to the three-dimensional (3-D) shape of the tumor by controlling the intensity of the radiation beam to focus a higher radiation dose to the tumor while minimizing radiation exposure to surrounding normal tissues. Treatment is carefully planned by using 3-D computed tomography (CT) images in conjunction with computerized dose calculations to determine the dose intensity pattern that will best conform to the tumor shape. Because the ratio of normal tissue dose to tumor dose is reduced to a minimum with the IMRT approach, higher and more effective radiation doses can safely be delivered to tumors with fewer side effects compared with conventional radiotherapy techniques. IMRT has the capability of sparing intestinal, rectal, and bladder tissues from receiving toxic doses of radiation.

• Intracavity Brachytherapy (ICBT) - This is a form of internal radiation which entails the placement of radioactive material inside the body either directly into, or near the tumor to deliver a therapeutic dose of radiation to the cervix, surrounding tissues, and pelvic lymph nodes. Recent advancements in this technique allow for more specific tailoring of dose (low dose or high dose) and area to be treated, while allowing reduced time required for treatment.

Radiation is very effective in destroying cancerous cells at the treated area, however, it can also damage adjacent healthy tissue. Side effects of radiation therapy may include:

• Fatigue
• Urinary frequency and incontinence
• Rectal inflammation and diarrhea
• Changes in the vagina that can make sexual intercourse uncomfortable
• Infertility
• Skin changes and loss of pubic hair

Late effects of radiation therapy may also include development of a fistula which is an abnormal connection between the rectum or bladder and the vagina. At times, surgery may be necessary for repair of fistulas or other radiation injuries.

Surgery

Surgery plays a major role in the treatment of cervical cancer, particularly in women with early-stage disease.