CERVICAL CANCER

Frequently Asked Questions

The Radixact System, the next-generation TomoTherapy® platform, has been designed to enable doctors to more effectively and efficiently deliver precise radiation treatments to more patients. The TomoTherapy platform represented a dramatic advance in the radiation oncology field, as the only system specifically designed for integrated 3D daily image-guidance with intensity modulated radiation therapy (IG-IMRT) to help patients control their cancer. The TomoTherapy technology, used in the Radixact System, has more than two decades of clinical evidence and has been used to help thousands of cancer patients. Today, the Radixact System is routinely used to treat a variety of cancers – from routine to complex tumors, those located in hard-to-reach areas, recurrent tumors and cancers of the skin and blood.

The FDA provided clearance for the TomoTherapy technology for the treatment of tumors anywhere in the body, including cervical cancers, in 2002. The next generation of the TomoTherapy platform, the Radixact System, was cleared in 2016. The use the TomoTherapy technology, as well as IMRT, are supported by published clinical studies.

  • An analysis of multiple, independent studies (meta-analysis) found that cervical cancer patients treated with intensity-modulated radiation therapy (IMRT) experienced significantly reduced acute gastrointestinal (GI) and genitourinary (GU) toxicities, and chronic GU toxicity, than patients in the control group treated with three-dimensional conformal radiation therapy (3DCRT) or 2DCRT 1.
  • A study evaluated the use of helical TomoTherapy to deliver whole pelvic IMRT in patients with locally advanced cervical cancer. Helical TomoTherapy treatment plans were compared to those created for conventional whole pelvic radiation therapy (WPRT). The study found treatment with TomoTherapy is a viable option. Additionally, the helical TomoTherapy treatment plans successfully reduced the radiation dose to be delivered to the rectum, bladder and intestines, compared to the conventional WPRT plans 2
  • A randomized, controlled study evaluating patients with locally advanced cervical cancer treated with whole pelvic conventional radiation therapy or IMRT found that IMRT was associated with significantly less acute GI toxicities and chronic GU toxicity compared with CRT, with comparable effectiveness outcomes 3.
  • Patients with cervical cancer were treated with IMRT or 3DCRT as part of a multi-treatment regimen. The study found that IMRT provides a good treatment option with reduced acute GI and GU toxicities compared to 3DCRT 4.
  • A treatment planning comparison study showed that, for cervical cancer patients who were treated with post-operative external beam radiation therapy, IMRT achieved better sparing of organs at risk, including the bladder, rectum and bowel, than 3DCRT 5.
  • Results of a randomized study designed to compare cervical and endometrial cancer patients’ perspective of acute toxicity and quality of life during treatment with standard pelvic radiation or IMRT found that IMRT resulted in less impact on bowel and urinary function during treatment. Patients treated with IMRT also reported a smaller decline in physical function and other treatment-related concerns over the course of their treatment 6.

Radixact treatment is available at many locations worldwide. TomoTherapy treatments are available at hundreds of locations worldwide.

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The helical design of the Radixact System – unique among radiation therapy systems – enables multiple 360-degree rotation radiation dose delivery as the treatment table moves the patient at a deliberate pace through the center of the system. The Radixact System revolves around you while thousands of “beamlets” – smaller than the radiation beams of conventional systems – are delivered to the tumor. Each beamlet can deliver a different dose of radiation. Different doses go to different parts of each tumor, with less damage to surrounding healthy tissue.


Integrated imaging and advanced dose-delivery capabilities enable your treatment team to create a more personalized treatment plan and confidently deliver the most precise dose of radiation, directly to the tumor. Radixact helical delivery also enables treatment of a full range of diseases, including larger, more complex tumors, multiple tumors, and recurrent tumors.

Radixact treatments are typically completed in four to six weeks, similar to conventional radiation therapy.

Helical delivery means that the source of the radiation beam(s) (the linear accelerator or linac), can move in multiple 360-degree rotations around the patient during treatment delivery while the treatment table moves the patient at a deliberate pace through the center of the system. Whereas conventional radiation therapy systems can only deliver radiation from a limited number of points, the helical delivery of the Radixact System helps to allow your treatment team to administer the accurate dose of radiation to the tumor from 360 degrees around the patient.

Radiation therapy is a treatment that uses high-energy x-rays (photons) to destroy cancer cells and control the growth of tumors. Radiation therapy works by damaging cells, disabling them from growing and dividing. The goal of any radiation treatment is to destroy cancer cells while minimizing dose to healthy tissue. As imaging technologies have advanced over the past several decades, radiation therapy has integrated those upgrades to help enhance dose delivery, improve outcomes and reduce the side effects of treatment.

Radiation is a proven cornerstone of effective treatment for many cervical cancers, and may be combined with other treatments including chemotherapy and brachytherapy. Radiation therapy is constantly evolving with the introduction of new technologies to the market. The Radixact System can deliver a highly advanced type of radiation therapy known as image-guided, intensity-modulated radiation therapy (IG-IMRT).

Intensity-modulated radiation therapy (IMRT) is a specialized form of external beam radiation therapy that varies the intensity of each radiation beam. IMRT can help clinicians shape the delivery of radiation to fit the contours of the tumor more accurately and precisely – and help minimize dose to surrounding organs and tissues.

Image-guided intensity-modulated radiation therapy (IG-IMRT) is a type of targeted external beam radiation therapy that enhances IMRT by using images acquired before each treatment to help ensure accurate patient and tumor positioning before delivery of the radiation treatment.

The Radixact System was designed to deliver an enhanced form of IMRT – image-guided intensity-modulated radiation therapy (IG-IMRT) – that uses images acquired before each treatment to help ensure accurate patient and tumor positioning. These images also help clinicians to determine the most appropriate treatment plan, including the amount of dose to deliver to the tumor and the margins surrounding it. By modulating the intensity of the radiation beams/beamlets, IG-IMRT enables clinicians to carefully shape the radiation dose to fit the contours of the tumor, while minimizing dose to surrounding organs and other healthy tissues. This precision and accuracy is particularly valuable when it comes to reducing the risk of side effects that may impact tissues and organs around the cervix such as the bladder, rectum and bowel.

There are good options for treating cervical cancers, and the right option depends on your specific diagnosis. The Radixact System is an ideal treatment option for a wide range of cervical cancers at various stages of the disease. The best way to determine if Radixact treatment is right for you is to find a Radixact treatment location and make an appointment to discuss your specific details.

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Most radiation side effects are minimal and last only a short time. Side effects can, however, be severe. Possible side effects could include:

  • Fatigue
  • Diarrhea
  • Nausea and vomiting
  • Skin changes
  • Bladder irritation, causing discomfort, an urge to urinate often, and sometimes blood in the urine
  • Vaginal pain
  • Menstrual changes and early menopause
  • Low blood counts


Long-term side effects include:

  • Vaginal stenosis, dryness and pain
  • Urinary issues
  • Fractures of the pelvis or hip
  • Rectal bleeding and pain
  • Swelling in the genitals and legs (lymphedema)


Ask your doctor for more details about the side effects of your specific radiation therapy.


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You can expect your Radixact treatment to require daily sessions, typically for four to six weeks. Because the Radixact System can deliver radiation continuously, the entire treatment process typically lasts 10-20 minutes – including patient set-up time.

Treatment sessions are non-invasive outpatient procedures, and no anesthesia is required. Most patients resume normal activity immediately after treatment sessions.

No anesthesia is required for Radixact treatment and treatment sessions are completed on an outpatient basis.

The majority of patients can continue normal activity during and immediately following Radixact treatment. Just as important, the Radixact System is designed to minimize dose to healthy tissues and reduce the incidence of side effects, with the goal of improving  patient quality of life both during and after treatment. In some circumstances, side effects may occur.

Most patients can continue normal activity during and immediately following Radixact treatment. Many patients experience minimal side effects and can quickly return to their daily routines.

Precisely delivering the prescribed radiation dose to the target is essential for optimizing long-term disease control. Additionally, because of the location of the cervix, precise delivery helps reduce the risk of irradiating healthy tissues and organs surrounding the tumor, such as bladder, rectum or bowel and the incidence of genitourinary or gastrointestinal side effects.

Because the precise targeting of the Radixact System significantly reduces irradiation of surrounding healthy tissues, some patients previously treated with conventional radiation therapy systems may be candidates for re-irradiation with the Radixact System, in the event of recurrence. Each patient should consult his physician regarding his or her own specific case.

Medicare and private insurance companies in the United States may reimburse image guided IMRT for cervical cancers subject to medical necessity and your health insurance plan constraints. Patients should contact a Radixact treatment center to determine if this procedure is a covered benefit under your health insurance plan and any out-of-pockets costs such as deductibles, co-insurances, and/or copayments.

Not every patient’s condition is effectively treated with IG-IMRT. Talk to your physician about your best options and come to a joint decision.

References:

1 Lin Y., Chen K., Lu Z. et al. Intensity-modulated radiation therapy for definitive treatment of cervical cancer: a meta-analysis. Radiat Oncol. 2018 Sep 14;13(1):177.

2 Hsieh C.H., Wei M.C., Lee H.Y. et al. Whole pelvic helical tomotherapy for locally advanced cervical cancer: technical implementation of IMRT with helical tomotherapy. Radiat Oncol. 2009 Dec 10;4:62.

3 Gandhi A.K., Sharma D.N., Rath G.K. et al. Early clinical outcomes and toxicity of intensity modulated versus conventional pelvic radiation therapy for locally advanced cervix carcinoma: a prospective randomized study. Int J Radiat Oncol Biol Phys. 2013 Nov 1;87(3):542-8.

4 Naik A, Gurjar OP, Gupta KL, Singh K, Nag P, Bhandari V. Comparison of dosimetric parameters and acute toxicity of intensity-modulated and three-dimensional radiotherapy in patients with cervix carcinoma: A randomized prospective study. Cancer Radiother. 2016 Jul;20(5):370-6.

5 Marjanovic D., Plesinac Karapandzic V., Stojanovic Rundic S. et al. Implementation of intensity-modulated radiotherapy and comparison with three-dimensional conformal radiotherapy in the postoperative treatment of cervical cancer. J BUON. 2019 Sep-Oct;24(5):2028-2034.

6 Klopp A.H., Yeung A.R., Deshmukh S. et al. Patient-Reported Toxicity During Pelvic Intensity-Modulated Radiation Therapy: NRG Oncology-RTOG 1203. J Clin Oncol. 2018 Aug 20;36(24):2538-2544.