Patients with gynecological malignancies who have received prior radiation or have recurrent malignancies present significant challenges to providers. Options for treatment have traditionally been limited to surgery; however, this can carry significant morbidity.
Here at UCLA we have specialized treatments that can help in difficult situations like this. The modality that is selected depends on multiple factors including the location of the recurrence, the size of the recurrence, the patient’s previous treatments, and the patients overall health.
Our team has extensive experience in something that few other departments can do which is interstitial brachytherapy. This is a highly skilled technique were a series of hollow tubes are inserted through the skin to encompass the area of recurrence. These hollow tubes serve as a matrix that allows a small source of radiation on the end of a cable to deliver radiation in a very precise way directly to the target. This type of treatment is called High Dose Rate brachytherapy. It is a highly effective and useful treatment in many different settings.
Not only can HDR brachytherapy be done by our team but it can also sometimes be used in collaboration with the Gynecologic Oncology team. There are situations were not all of the tumor can be taken out and a focused amount of radiation to this residual area is necessary. At the time of the operation we can place these hollow tubes so that we can post-operatively deliver focused doses of radiation.
3D rendering of an example where brachytherapy catheters were placed at the time of surgery.
Another treatment option that is available is stereotactic body radiation therapy (SBRT). This is a technically advanced treatment that allows us to safely and confidently deliver focused doses of radiation to a target while dramatically reducing additional radiation dose to surrounding tissues. Here at UCLA we have been using SBRT to treat multiple body sites including lung, liver, and pancreas. We have also now started to use this is selected cases for patients with gynecological cancers.