Radiation therapy is the use of high-dose X-rays to destroy cancer cells. Radiation therapy may be used to treat endometrial cancer after hysterectomy or as the primary therapy, particularly for women who cannot have surgery. The two types of radiation therapy that may be used to treat endometrial cancer are:

• Internal radiation therapy (brachytherapy), in which radioactive materials (radioisotopes) are placed into the uterus or other areas where the cancer cells are found.
• External beam radiation therapy, in which radiation comes from a machine outside the body.

What To Expect After Treatment

In brachytherapy, tiny tubes of radioactive material are inserted through the vagina and left in the uterus for 2 to 3 days. Brachytherapy may be done in the hospital or as on an outpatient basis.

External beam radiation therapy is usually done in an outpatient treatment center. A typical therapy course is radiation treatments 5 days a week for 4 to 6 weeks.

Radiation therapy may cause side effects, including:

• Fatigue.
• Dryness, itching, tightening, and burning in the vagina.
• Red, dry, tender, itchy skin.
• Moist, weepy skin (later in the treatment).
• Hair loss in the treated area.
• Loss of appetite.
• Diarrhea.
• Frequent and uncomfortable urination.
• Reduced white blood cell count.

For long-term side effects, see the Risks section below.

Radiation therapy may make sexual intercourse uncomfortable. You may have to wait until after treatment is finished to resume sexual intercourse.

Why It Is Done

Radiation therapy is usually given after surgery (adjuvant therapy) for endometrial cancer. Adjuvant radiation may be recommended for women who have a high risk for the spread of the cancer. If a woman cannot undergo surgery, she may receive radiation therapy alone, but cure rates are slightly lower than with surgery.

Radiation therapy may be used at different points of treatment, depending on the stage and grade of the endometrial cancer.

• Stage I: Radiation therapy is not usually used if surgery effectively removes the cancer. If cancer is found deep in the uterine muscle (myometrium), radiation of the pelvis may be given.
• Stage II: Radiation therapy may be used before or after surgery. If cancer is present in the cervix, radiation may be used after surgery.
• Stage III: Radiation therapy and surgery are the standard treatment options. If surgery is not recommended, radiation therapy alone may be used. Radiation therapy may also be used if more extensive cancer is discovered during surgery.
• Stage IV: Radiation therapy may be used if the cancer is contained in the pelvic region but is usually not recommended if the cancer has spread (metastasized) to other parts of the body.

Endometrial cancer may recur. Radiation therapy may be used to control symptoms and increase comfort. Radiation therapy may cure your cancer if the cancer is confined to your vagina and radiation therapy has not been used before.

How Well It Works

Radiation therapy for endometrial cancer is used primarily as adjuvant therapy with surgery (hysterectomy and bilateral salpingo-oophorectomy). It is usually not recommended unless you have a high risk of cancer spreading beyond the uterus. Adjuvant radiation therapy can reduce cancer recurrence in the pelvis and vagina.^{1, 2}

Risks

Having radiation therapy to any part of the pelvis can cause side effects such as bladder irritation. These side effects may stop after treatment is finished.

Other side effects of radiation can include:³

• Bowel obstruction.
• Abdominal cramps.
• Frequent bowel movements or diarrhea.
• Chronic bladder irritation.
• Vaginal scarring (vaginal fibrosis).

What To Think About

For some women with stage 3 or 4 cancer, chemotherapy with radiation may work better than radiation alone.⁴

Radiation therapy to the pelvis causes permanent sterility. If your cancer is in a very early stage and is low grade (slow-growing) and you want to be able to have children, progestin hormone therapy may be an option rather than a hysterectomy and/or radiation therapy.

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Citations

1. Cannistra SA (2004). Gynecologic cancer. In DC Dale, DD Federman, eds., Scientific American Medicine, vol. 3, part 12, chap. 10, pp. 9–11. New York: WebMD.

2. Creutzberg CL, et al. (2003). Survival after relapse in patients with endometrial cancer: Results from a randomized trial. Gynecologic Oncology, 89: 201–209.

3. Creutzberg CL, et al. (2000). Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: Multicentre randomised trial. Lancet, 355: 1404–1411.

4. Randall ME, et al. (2006). Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: A gynecologic oncology group study. Journal of Clinical Oncology, 24(1): 36–44.