PHYSICO-DOSIMETRIC AND RADIOBIOLOGICAL ASPECTS OF MODERN BRACHYTHERAPY OF ONCOGYNAECOLOGICAL PATIENTS
DOI:
https://doi.org/10.15407/oncology.2025.01.076Keywords:
brachytherapy, cancer patients, radiation complications, radiobiological support, quality of lifeAbstract
Modern radiation oncology requires individualized prediction of radiation reactions and complications from normal tissues surrounding the irradiated tumor. Currently, contact radiotherapy — brachytherapy using a 192Ir radiation source — is used to treat gynecological cancer in many countries around the world. This uses the volumetric effect on healthy tissues surrounding the tumor, which are exposed to less radiation. This is the so-called “double concern” phenomenon, in which, depending on the physical and dosimetric planning, a small volume of tissue may be exposed to ionizing radiation at a dose that is less or more than planned. Nevertheless, even with the use of modern equipment, there is still a real threat of radiation complications in normal tissues that fall into the zone of therapeutic radiation. For example, during radiation treatment of patients with gynecologic cancer, the pelvic organs are primarily affected. Therefore, the identification of patients at a high risk of radiation complications before the start of radiation therapy remains the challenging problem of modern oncology. Based on the literature data and our own research, the way to determine radiobiological indicators that takes into account the mechanisms of radiation damage formation and predictors of the increased risk of complications of radiation therapy in cancer patients is outlined. The article focuses on the analysis of the quality of life of treated patients. The information on the quality of life is obtained based on the questionnaires filled by the patients themselves as well as the objective analysis of the clinical parameters. Summarizing the material presented in this article, it should be emphasized that brachytherapy is recognized as a modern high-tech and effective method of radiotherapy for gynaecological cancer. Radiobiological support of brachytherapy allows predicting the risk of developing radiation complications, which increases its effectiveness and the quality of life of treated patients.
References
Ivankova VS, Domina EA, Khrulenko TV, et al. Iridium-192 radiotherapy benefits in the management of gynecological tumors. Problems of radiation medicine and radiobiology 2020; 25: 569–578. https://doi.org/10.33145/2304-8336- 2020-25-569-578
Kim D, Wang-Chesebro A, Weinberg, et al. High dose rate brachytherapy using inverse planning simulated annealing for locoregionally advanced cervical cancer: a clinical report with 2-year follow-up. J Radiat Oncol Biol Phys 2009; 75 (5): 1329–34. https://doi.org/10.1016/j.ijrobp.2009.01. 002
Ivankova VS, Domina EA, Matviyevska, et al. Peculiarities of brachytherapy of secondary vaginal cancer taking into account the radiobiological issues. Ukr Radiol J 2017; 25 (2): 123–7. (in Ukrainian)
Salani R, Backes FJ, Fung MF, et al. Post-treatment surveil- lance and diagnosis of recurrence in women with gyneco-
logic malignancies: Society of Gynecologic Oncologists recommendations. Am J Obstet Gynecol 2011; 204 (6):
–78. https://doi.org/10.1016/j.ajog.2011.03.008.
Joiner M, Kogel A. Basic clinical radiobiology. 5th edn. Boca Raton, FL: CRC Press/Taylor & Francis Group; 2019. 350 p.
Domina EA, Philchenkov A, Dubrovska A. Individual response to ionizing radiation and personalized radiotherapy. Crit Rev Oncog 2018; 23 (1–2): 69–92. https://doi.org/10.1615/ CritRevOncog.2018026308
Levine DA, De Los Santos J, et al. Handbook for prin- ciples and practice of gynecologic oncology. Wolters Kluwer health. 2020. 288 p.
Creasman W, De Geest K, Di Saia P, et al. Significance of true surgical pathologic staging: a Gynecologic Oncology Group Study. Am J Obstet Gynecol 1999; 181 (1): 31–4. https://doi.org/10.1016/s0002-9378(99)70431-x
Eifel PJ, Berek JS, Markman MA. Cancer of the cervix, vagina, and vulva. In: Cancer: Principles and Practice of Oncology. 9th ed. Lippincott Williams & Wilkins. 2011: 1311–44.
Kim D, Wang-Chesebro A, Weinberg et al. High-dose rate brachytherapy using inverse planning simulated annealing for locoregionally advanced cervical cancer: a clinical report with 2-year follow-up. J Radiat Oncol Biol Phys 2009; 75 (5): 1329–34. https://doi.org/10.1016/j.ij obp.2009.01. 002
Domina EA, Ivankova VS. Radiosensitivity predictors of non-malignamt cells in cancer patients. Ukr Radiol J 2018; (2): 39–40. (in Ukrainian)
Domina EA, Makovetskaya LI, Grinchenko OA, et al. Practi- cal approaches to detection of endometrial cancer patients with increased risk of complications of radiation therapy on the basis of predictors of radiosensitivity of cells from the tumour environment. Methodical recommendations. Ministry of Health of Ukraine. 2021. 28 p.
Lacombe J, Azria D, Mange A, Solassol J. Proteomic ap- proaches to identify biomarkers predictive of radiotherapy outcomes. Expert review of proteomics 2013; 10 (1): 33–42. https://doi. org/10.1586/epr.12.68
Brzozowska K, Pinkawa M, Eble MJ, et al. In vivo versus in
vitro individual radiosensitivity analysed in healthy donors and in prostate cancer patients with and without severe side eff after radiotherapy. Int J Radiat Biol 2012; 88 (5): 405–13. https://doi. org/10.3109/09553002.2012.666002
Chekhun V. Modern landscape of innovative technologies in optimizing the quality of life of cancer patients. Exp Oncol 2024; 46 (4): 281–8. https://doi.org/10.15407/exp- oncology.2024.04.281
