Radiotherapy of cancer of cervix uteri.

Among the malignant tumours of womanish privy parts takes first seat.

Classification of cancer of cervix uteri TNM:

T₀ — a tumour is not determined;

T_{is (in situ)} — carcinoma of in situ;

T₁ — carcinoma is limited by the cervix uteri;

T₂ — karcinoma is widespread outside the cervix uteri, does not ainjured the walls of pelvis and/or pass on a vagina to the its lower third, don’t infiltrated or infiltrated parametrium;

T₃ — carcinoma is widespread on lower third of vagina and/or spreads to the walls of pelvis, may to arise hydronephrosis (as a result injure ureter by tumour);

T₄ — a tumour is widespread on the mucous membrane of urinary bladder or rectum and/or spreads outside a small pelvis;

N₀ — there are not metastases in regionar lymph nodes;

N₁ — there are metastases in regionar lymph nodes;

M₀ — there are not remote metastases;

M₁ — there are remote metastases.

Radiotherapy cancer of cervix uteri. In 1938 Tod and Meredіt suggested are performed using point A and point B for irradiating cancer of cervix utery (see fig. 8.2.). Point A is situated on 2 cm of lateral middle axis of uterine channel (primary tumor). Point B is situated thereon level and is remote from the axis of uterus on 5 cm (area of lateral parametrium and lymphatic nodes of lateral wall of pelvis – area of regional metastases).

Fig. 8.2. Position of points A and B in small pelvis.

Stage of in situ (T_isN₀M₀) — surgical medical treatment: ekstirpatsiya uteruses with the segment of vagina of s/bez appendages depending on age; to the patients which have contra-indications to surgical medical treatment from ekstragenitalnoy pathology and yellow sear leaf, 5 Gr conduct the intracavitary gamma-therapy (ICGT), TBD 50 Gy 2 – 3 sessions in a week by the hose gamma-terapevticheskogo vehicle “Agat-V” (a radio-active package to the hearth of defeat is tricked into automatically without direct participation of personnel of separation of radio therapy).

Stage I ( T₁N₀M₀) — the combined medical treatment: extripation uteruses, post-operation the DGT shallow fractionating to TBD 40 – 45 Gy in a point B.

Stage II (T₂N₀M₀) —combine radio therapy: RGT in a point A 20 – 25 Gy, in a point B 40 – 42 Gy by the shallow fractionating, ICGT in a point A 50 Gy (5 Gy, 2 – 3 times per a week), in a point B 12,5 Gy. TBD from both methods in a point A 75 Gy, in a point B 54,5 Gy; polychemicaltherapy is possible on occasion.

Stage III (T_1-3N₁M₀) —combine radio therapy by the split course: DGT in two stages (a 1 stage of SD in points A and B to 30 Gy, a 2 stage in 2 weeks of SD in a point A 5 Gy, in a point B 16 Gy), VPGT SD in a point A 50 Gy, in a point B 12,5 Gy — SD from both methods in a point A 85 Gy, in a point B 58,5 Gy; polychemicaltherapy is possible on occasion.

Stage IV ( T_0-4N₁M₁) — palliative DGT, palliative polychemicaltherapy.

The five-year survival after radio therapy of cancer of cervix uteri makes: at the first stage to 90%, at the second stage – 60,2%, at to 3-her the stages – 35,6%. On the average for all stages of cancer of cervix uteri the five-year survival makes 58,5% cases.

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