Chemo before CRT cuts Cervical Cancer return risk by 35%

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Taking the right course of action after being diagnosed with cancer is imperative, as the timing and combination of therapies is just as important as the type of treatment in the first place.

A recent trial

Results from a recent study have shown that giving patients with cervical cancer a short course of chemotherapy before they begin their usual treatment of chemoradiation (CRT) can reduce the risk of the tumour returning or of death by as much as 35 per cent.

The findings, which were funded by Cancer Research UK, could change the way women with cervical cancer are treated.

Over the last 24 years, they have been given a combination of chemotherapy and radiotherapy to reduce the size of their tumour and kill cancer cells.

However, the study has shown giving a six-week course of chemotherapy first could boost their chances of surviving.

Executive director of research and innovation at Cancer Research UK Dr Iain Foulkes noted that “timing is everything when you’re treating cancer”.

“The simple act of adding induction chemotherapy to the start of chemoradiation treatment for cervical cancer has delivered remarkable results in this trial,” he added.

Indeed, 80 per cent of the participants in the study, who were recruited from all over the world, were still alive five years after their treatment, while almost three-quarters had not seen their cancer return or spread to other parts of their body.

This is in comparison with the 72 per cent who were still alive after just being given CRT for their cervical cancer treatment, and the 64 per cent whose cancer had not returned or spread.

Dr Foulkes noted that this breakthrough could help with other cancers, not just cervical cancer.

He said: “A growing body of evidence is showing the value of additional rounds of chemotherapy before other treatments like surgery and radiotherapy in several other cancers.”

As the drugs are already widely available, it can be delivered quickly, helping people to eradicate the cancer as soon as possible, and increase their chances of surviving.

Subsequently, having a six-week course of chemotherapy before CRT could become a standard practice in the future.

Advances in radiation therapy

Although this breakthrough has been hailed as the biggest drug advancement in 20 years, it is not the only progression there has been for cervical cancer treatment.

Radiation therapy has also advanced over the last few years, including volumetric modulated arc therapy (VMAT).

With this technology, the strength and angle of the radiation alters as the machine rotates, so the radiation is properly targeted on to the areas of concern.

This external radiation therapy gives the tumour the maximum dose of radiation, while still minimising the dose the surrounding areas receive.

Brachytherapy is also effective, as it delivers a dose of radiation directly into the tumour. It does this by placing the seeds, ribbons or capsules into a tube, which knows the exact positioning thanks to MRI scans and computed tomography.

This internal radiation therapy really allows doctors to target the tumour, eradicating any cancer cells from the area. While the tumour can receive a high dose of localised radiation, the healthy tissue will not be damaged.

Immunotherapy options

Immunotherapy is also an option for cervical cancer patients, as they respond well to the treatment due to the fact the cancer is caused by an infection.

It works by using the body’s immune system to destroy the cancer cells.

There have also been advancements in the development of a treatment that involves manipulating lymphocytes, which are immune cells that are found inside the tumour. By harvesting the lymphocytes and making them reproduce and multiply, scientists can then use them to attack the tumour by placing them back inside of it.

Signs of cervical cancer to look out for

Like any other type of cancer, the earlier cervical cancer is discovered, the better the prognosis is likely to be.

What’s more, if it is found as soon as possible, there are more options available with regards to treatment.

However, cervical cancer can be hard to discover, as it does not cause external lumps, such as with breast cancer.

Instead, it begins in the cells of the cervix. They then go through a process called dysplasia, turning them into abnormal cells, which then develop into cancer cells and spread further into the cervix tissue.

It is caused by long-lasted HPV infections, which can be transmitted through sex or skin-to-skin contact.

These days, older children can receive a vaccine to protect themselves from the HPV infection, which will reduce incidences of cervical cancer in the future. Although it is not usually given to people over the age of 26, it could be effective for some adults to avoid getting new HPV infections.

However, for those who have not received the jab, the only way to detect whether they have cervical cancer is through a Pap screening. This detects whether there are abnormal cells in the cervix that need further investigation.

They should also be on the lookout for common symptoms of cervical cancer, as they could flag these up with their doctor and request an earlier screening if they are concerned.

Signs of early stage cervical cancer include:

  • Bleeding after sex
  • Bleeding between periods
  • Heavier or longer periods than normal
  • Pain during sex
  • Pelvic pain
  • Bleeding after menopause
  • Vaginal discharge with a strong odour or containing blood

If the cancer has spread to other parts of the body, there are other signs to look out for. These include:

  • Lethargy
  • Abdominal pain
  • Painful bowel movements
  • Bleeding from the rectum when having a bowel movement
  • Blood in the urine or painful urination
  • Leg swelling
  • Dull backaches

Although these could also be caused by countless other conditions, if you are experiencing more than one or are concerned about the symptom, it is sensible to seek advice from a doctor as soon as possible.

If it turns out to be cervical cancer, it is best to start treatment, whether this includes chemotherapy followed by CRT, just a course of CRT, surgery, or immunotherapy, as soon as possible for the best results.

Your oncologist will be able to advise on the right course of action to take for your stage of cancer, age, and general health, so you have the greatest chances of surviving.

Is real-time Radiotherapy diagnostic imaging now possible?

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One of the greatest advances in radiotherapy treatments might be within reach if a study into high-performance medical image construction can be widely applied.

Radiotherapy is typically a two-step process, where someone steps into a radiotherapy centre, and has their body examined through advanced diagnostic equipment before a treatment plan is carefully put in place.

A limitation to this approach that has been around since the earliest radiotherapy treatments and earliest uses of advanced medical imaging is that it takes quite some time for the images to be reconstructed in a way that can be interpreted by specialists.

This can mean that between the medical scan and treatment, growths, lesions and tumours could have moved slightly, something that must be factored into radiotherapy treatments and can make certain more complex forms of radiotherapy more difficult.

The position of organs changes a lot, particularly when people lie down and organs sink towards the back due to the effects of gravity, as well as in the process of breathing. The longer between the scan and the treatment, the more pronounced these changes will be, and it is unfeasible for obvious reasons to stop this completely.

This is why the Gamma Knife method uses a rigid frame to hold a person’s head in place during the treatment to ensure as much accuracy as possible

The ideal approach would be to combine diagnosis and treatment into a single process, often known as online or guided radiotherapy. Here, diagnostic imaging would be updated in real-time so treatments could be highly accurate, with much less damage to surrounding healthy tissue.

A research team at Imperial College London, funded by the Institute for Cancer Research and Cancer Research UK, have published a study that reduced the amount of time needed to create a 4D-MRI image from 17 minutes to just one, with an accuracy level of 99 per cent.

This not only allows for more accurate, faster treatments but also allows for the treatment of tumours or lesions close to organs where previously the risk of collateral damage made them too dangerous to consider.

The research team intend to publish the code for the image reconstruction technique they used so it can be adopted widely, so these changes could come potentially very quickly.

Can pre-Radiotherapy Chemotherapy help with Cervical Cancer?

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In what oncologists described as possibly the biggest breakthrough in cervical cancer treatment in two decades, a course of chemotherapy before radiotherapy is projected to dramatically improve the success rates of cancer treatment.

This is according to the results of the GCIG INTERLACE trial, a phase III clinical trial of 500 patients with cervical cancer who were set to undergo chemoradiation, a combination treatment for radiotherapy and chemotherapy which is more effective together than each treatment is on its own.

Half of them received a six-week course of Taxol/Carbo, a combination chemotherapy treatment used to treat lung, ovarian and cervical cancer, before their standard course of treatment.

The other half only received this standard course of treatment, which consisted of cisplatin, brachytherapy radiotherapy and conventional radiotherapy treatments for cervical cancer every week.

The group that received the short course of chemotherapy found that the rate of return for cancer after the treatment after five years was 35 per cent less in the pre-radiotherapy chemotherapy group compared to the control group, the biggest improvement in outcomes seen in over 20 years.

The biggest benefit besides the improved survival rates is that Taxol/Carbo is already approved for chemotherapy, is widely used, accessible and inexpensive, meaning that it can be added to a standard course of treatment quickly.

However, as with most cancer treatments, not every case is the same and therefore not every cervical cancer patient will be suitable for this treatment.

The study was primarily on women in the early stages of cancer before it had started to spread, and it is not known how effective it would be for more advanced cervical cancer cases, although improved screening and diagnosis are helping to offset this by getting people treated sooner.

An extra course of chemotherapy also has the typical side effects of chemotherapy, such as nausea, sickness and damage to the hair.

However, more options for treatment are always beneficial to patients, as it increases the chance of finding the most suitable one for a given case.

Why is Stereotactic Radiosurgery often called Gamma Knife?

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One of the most fascinating aspects of stereotactic radiosurgery is that despite being called a surgery, it is able to carefully target and destroy tumours without the need to open up a part of the body and cut them out.

Sometimes, when researching stereotactic radiosurgery (SRS) ahead of booking an appointment, you may come across the term Gamma Knife, which is sometimes used as an interchangeable term to describe a type of non-surgical targeted radiotherapy.

This can cause confusion, but it is easier to consider Gamma Knife as a particular type of targeted stereotactic radiosurgery aimed at treating brain tumours and lesions.

The reason for the confusion is a matter of chronology; the Gamma Knife method was one of the earliest successful forms of SRS, first conceived by Lars Leksell in 1949 as a way to treat small lesions on the brain that would be too dangerous to manage with conventional surgery.

It took until 1968 for the Gamma Knife itself to be first implemented at the Karolinska Institute, but once it was it became the defining type of SRS for many years to the point that a lot of people would use the term Gamma Knife as a genericised trademark for all types of targeted radiotherapy.

However, as the concept of SRS evolved and became capable of treating many other parts of the body besides the brain, calling all treatments in that category Gamma Knife radiosurgery became increasingly inaccurate.

With alternative treatments available that can treat a wide variety of tumours all over the body, many radiologists prefer to use the more general term stereotactic radiosurgery unless specifically referring to the Gamma Knife technique, including a headframe, helmet and array of radioactive beams.

Where this becomes most confusing is with the CyberKnife system, a versatile SRS system inspired by the Gamma Knife technique but able to treat tumours in the throat, liver, pancreas, brain and prostate.

Ultimately, there is a wide range of SRS treatments, and Gamma Knife is one of many.

Primary vs. Secondary Cancer: How Radiotherapy differs

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Cancer is a relentless adversary, but the battle against it can vary significantly depending on whether it’s primary or secondary cancer. Understanding these distinctions is vital for patients and their families, especially when it comes to the role of radiotherapy in the treatment plan.

Primary Cancer: The Initial Encounter

Primary cancer is where the disease originates. It begins in a particular organ or tissue, often leading to a localised tumour. The management of primary cancer typically involves a combination of treatments, which may include surgery, chemotherapy, immunotherapy and radiotherapy.

When it is employed for primary cancer, the goal is often to target the tumour directly while minimising damage to surrounding healthy tissue. The treatment plan is customised for each patient, taking into account the tumour’s location, size and type.

Secondary Cancer: The Challenge of Metastasis

Secondary cancer, on the other hand, results from the spread of cancer cells from the primary site to other parts of the body. These metastatic tumours can be located in distant organs or tissues, making treatment more complex.

Radiotherapy for secondary cancer aims to target and control the metastatic tumours while also considering the potential risks to the patient’s overall health. The approach is often more palliative, focusing on symptom relief, pain management and improving the patient’s quality of life.

Differences In Radiotherapy Approaches

The main difference between primary and secondary cancer radiotherapy lies in the intent and scope of treatment. Primary cancer therapy is typically curative, aiming to eradicate the tumour. In contrast, secondary cancer therapy is usually palliative, focusing on symptom control and extending life while maintaining a good quality of life.

What To Expect

For both primary and secondary cancer therapy, patients can expect a thorough evaluation and treatment planning process. Imaging scans, such as CT or MRI, help determine the precise location and size of the tumours. The treatment team will work together to create a customised plan that balances the treatment’s effectiveness with minimising side effects.

Side-effects can include fatigue, skin irritation and discomfort, depending on the treatment site. Patients are closely monitored throughout the treatment course, and adjustments are made as needed to manage side effects and ensure the best possible outcome.

In conclusion, while the specifics may differ for primary and secondary cancer, the overarching goal remains the same: to provide patients with the best possible care and treatment. The choice of as part of the treatment plan depends on the individual circumstances of the patient and the expertise of the medical team.

What are the advantages of having Gamma Knife Radiotherapy?

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Hearing that you have a brain tumour is devastating not only for yourself, but for everyone who loves you. However, the good news is there are several options when it comes to treatments, including gamma knife radiotherapy.

What is gamma knife radiotherapy?

Otherwise known as stereotactic radiosurgery, gamma knife radiotherapy involves using beans of gamma rays to treat the tumour.

This concentrated dose targets the cancer cells, while a lower dose is used on surrounding tissue to limit damage to healthy cells.

Why are more choosing gamma knife radiotherapy over surgery?

There are many reasons why patients are opting for gamma knife radiotherapy performed by specialist consultants like Mr Neil Kitchen at Amethyst Radiotherapy.

Here are just a few:

  • No need for an incision 

One of the many benefits of this form of treatment has to be that it is non-invasive.

It does not involve making an incision, meaning there is no need for anaesthesia. There is, therefore, less recovery time and less trauma to the skull and brain.

  • Quick recovery

As a result, patients can be in and out of the hospital within a day with the procedure lasting up to just 70 minutes, without requiring an overnight stay.

In fact, those who have a brain tumour operation might need to remain in hospital for between three and ten days, as it carries a risk of infection, blood clots, chest and breathing difficulties, wound problems, and allergic reactions.

There could also be swelling in the brain, which needs to be monitored very closely by medical staff.

With regards to long-term consequences of brain surgery, patients might have difficulty walking, find it hard to concentrate or remember things, experience behaviour changes, feel weakness in an arm or leg, have speech problems, feel fatigue, or suffer from epilepsy.

Consequently, gamma knife radiotherapy is preferential when a high risk patient is involved or the tumour is too difficult to reach with conventional surgery.

  • Minimal side-effects

Unlike neurosurgery, the side-effects of gamma knife treatment is minimal. Patients might experience some headaches and nausea, but these are rare, and when they do occur, are only temporary.

Typically, patients can carry on with their usual activities the following day, as they have not had to undergo surgery or have anaesthetic.

  • Precision 

Another reason why gamma knife treatment is preferable to neurosurgery is the fact it is extremely precise.

As the rays are aimed at their specific targets and the dose is customised for each patient, the impact on surrounding tissue, blood vessel structures and other critical nerves are dramatically reduced.

This also means it can be used to treat those tumours that are incredibly hard to reach. In these cases, neurosurgery might not be a viable option, as surgeons will not be able to access the tumour to remove it in its entirety.

However, radiotherapy can still target the cancerous cells wherever they are in the brain.