Gynecologic Cancer Treatment Overview
As the only National Cancer Institute-Designated Comprehensive Cancer Center in Georgia, Winship is at the forefront in the treatment of gynecologic cancers, conducting innovative research and clinical trials that are transforming how these cancers are identified, treated, and survived.
The radiation oncologists at Emory Proton Therapy Center work with the multidisciplinary cancer teams at Winship, which include experts in gynecology, gynecologic oncology, medical oncology, radiology, pathology, supportive oncology, dieticians, social workers, physical therapy, and cancer rehabilitation. Your radiation oncologist will work closely with these other specialists to customize your treatment plan and coordinate your care. We can also partner and coordinate with a patient’s existing care team, whether they are across town or around the world.
Proton Therapy for Gynecologic Cancer
A gynecologic cancer can be one of the biggest challenges you and your family will ever face. Our team is dedicated to helping you meet that challenge through supportive care using the most advanced treatments available. Proton therapy may be a more precise radiation option for treatment of your cancer to help protect the function of important nearby organs like the bowels, bladder, and genitals, as well as reducing the risk of developing a future cancer. Our cancer specialists will work with you to develop a personalized treatment plan which aims for fewer side effects and improved quality of life.
What We Treat
- Cervical cancer
- Endometrial cancer
- Pelvic or paraaortic lymph node metastases
Gynecologic Proton Radiation Oncologist
Dr. Jill Remick
Benefits of Proton Therapy
In treatment of gynecologic cancers, proton therapy can reduce or avoid radiation to surrounding healthy tissue and organs. Depending on the tumor location and type, proton therapy may achieve the following benefits:
- Reduced risk of frequent urination or stinging or burning with urination during treatment, or of chronic urinary problems after treatment.
- Reduced risk of nausea and diarrhea during treatment.
- Reduced risk of rectal soreness (proctitis) during treatment and of chronic rectal problems after treatments such as rectal bleeding or ulceration.
- Reduced risk of skin and mucosal irritation of sensitive tissues during radiation.
- Reduced radiation to the bone marrow and circulating lymphocytes, which may help support the function of the immune system in taking on cancer.
- Reduced risk of low blood counts (anemia, neutropenia) which may support the body’s tolerance of chemotherapy.
- Reduced or avoidance of radiation to normal tissues reduces the risk of developing a future second tumor or cancer, which is most relevant in younger patients, those with a good prognosis and a long life expectancy, and those patients who may have genetic conditions putting them at higher risk for developing other cancers.
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What to Expect with Proton Therapy
The first step in your care is a consultation. During consultation, we review your medical history, perform a physical exam, decide if any additional tests are needed, discuss all radiation options that may be appropriate for your treatment plan, make recommendations, and answer questions.
To plan your treatment, you will undergo a “simulation” or planning session. During this visit our radiation therapists will help position you the way you will be treated each day. A CT scan will be done to create a picture of you in the treatment position to design your radiation plan. Some patients also undergo an MRI during this visit to help identify the target for treatment. It normally takes 10 days for the team to design the proton treatment plan and perform the quality assurance checks before treatment begins.
Depending on the type of tumor and stage, proton therapy may be delivered over one to three weeks or six weeks of therapy. Typically, radiation is given once daily during the weekdays, Monday through Friday. For those receiving five treatments or fewer, proton therapy may be delivered every other day. While some situations are treated with radiation alone, proton therapy is often integrated with surgery, chemotherapy, immunotherapy, or other cancer treatments as part of a comprehensive plan of care. Radiation treatment of many gynecologic cancers also involves a portion of the treatment being given with brachytherapy, a procedure in which radiation is placed in or near the tumor.
Like other types of radiation, proton therapy treatments are invisible and painless. Most gynecologic cancer treatments average 30 minutes each day in the treatment room.
Patients are seen by the radiation oncology physician team weekly during treatment to monitor progress, answer questions, address concerns, and manage any side effects from treatment. Your radiation oncologist will discuss a plan to assess response to treatment and for long-term follow-up after therapy.
Studies on Proton Therapy in Gynecologic Cancer
Our team has identified these studies as examples of the clinical benefits of proton therapy in gynecologic cancer.
Initial report of pencil beam scanning proton therapy for posthysterectomy patients with gynecological cancer
This retrospective study reported on a series of 11 patients with gynecologic cancer (cervical, vaginal, or endometrial cancer) who underwent a hysterectomy (surgery to remove the uterus) and needed radiation treatment to the pelvis. In these women, proton therapy was used instead of x-ray therapy for treatment of the pelvis. The study found that proton therapy was feasible and was able to reduce the volume of the pelvic bone marrow, bladder, and small bowel receiving low and moderate doses of radiation compared to IMRT (x-ray) radiation. It is hoped that reducing radiation to the bone marrow can reduce the risk of low blood counts (anemia, neutropenia) which may support the body’s tolerance of chemotherapy, as well as support the function of the immune system in fighting cancer. Reducing radiation to the bowel may reduce the risk of nausea and diarrhea.
Inter-fraction motion robustness and organ sparing potential of proton therapy for cervical cancer
This planning study evaluated pencil beam proton therapy in 12 women with cervical cancer who had previously been treated with IMRT (x-ray) radiation. The authors were interested in the motion of organs within the pelvis that naturally occurs during a course of radiation and examined whether proton therapy plans would be appropriate. They found that proton plans were equally good as IMRT at covering the radiation target but provided significantly better sparing of normal bowel (intestines) and bone marrow.
Which cervical and endometrial cancer patients will benefit most from intensity-modulated proton therapy?
This planning study evaluated the potential benefits of pencil beam proton therapy versus IMRT (x-ray) radiation in women with cervical or endometrial cancer who require radiation therapy . The authors note that when radiation volumes needs to be extended upwards to cover the paraaortic lymph nodes, proton therapy provided clinically relevant sparing of the kidneys, spinal cord, bone marrow, and bowel. By reducing unnecessary radiation, the authors anticipate proton therapy could reduce the risk of nausea and vomiting during radiation and reduce the risk of low blood counts (anemia, neutropenia) which may support the body’s tolerance of chemotherapy, as well as support the function of the immune system in fighting cancer.
PROTECT: Prospective Phase-II-Trial Evaluating Adaptive Proton Therapy for Cervical Cancer to Reduce the Impact on Morbidity and the Immune System
This article describes an ongoing trial in Europe comparing pencil beam proton therapy with IMRT (x-ray) radiation for women requiring radiation for cervical cancer. The goals of the study are to demonstrate the ability of proton therapy to reduce unnecessary radiation to the bone marrow and to the bowel (intestines) with the hope that this will reduce toxicity and improve quality of life for women with cervical cancer.
Proton Therapy Reduces Normal Tissue Dose in Extended-Field Pelvic Radiation for Endometrial Cancer
This paper reports on 25 women with endometrial cancer who were treated with radiation where the radiation volume needs to be extended upwards to cover the paraaortic lymph nodes. Seven patients were treated with pencil beam proton therapy and 18 were treated with IMRT (x-ray) radiation. Compared to IMRT, the proton therapy plans significantly reduced unnecessary radiation to the bowel (intestines), bladder, and pelvic bone marrow. The authors found that high-grade hematologic toxicities (reduced blood counts) were seen only in IMRT patients and not with proton therapy.
Stephen, a 36-year old father from Columbus, Georgia, is one of the almost 2000 patients who have been treated at the Emory Proton Therapy Center since it opened in December 2018. He completed six weeks of proton therapy to treat a brain tumor.
Dusty was diagnosed with prostate cancer, an uncontrolled growth of cells in the prostate gland. Upon further consultation and research, he was treated with proton therapy and is excited to see an advanced form of radiation therapy is available at the Emory Proton Therapy Center.
Proton therapy gave Zack his best shot at treating a spinal tumor that had come back. Zack was one of the first patients treated at the Emory Proton Therapy Center after it opened in 2018. The treatments, every weekday for six weeks, took less than one hour of his day and gave Zack the greatest odds of a long life with his wife and children.
Jill was diagnosed with salivary gland cancer and referred to Winship Cancer Institute of Emory University. She needed surgery, chemotherapy, and radiation therapy. A team of Winship experts worked together to coordinate her care, including proton therapy at the Emory Proton Therapy Center. Jill credits her care team for having the expertise and the necessary tools to give her the best cancer care possible.
Tony was diagnosed with prostate cancer in 2019 and sought care from experts at Emory Proton Therapy Center. He’s confident that the advanced radiation therapy gave him the best cancer treatment possible and says the comfort and care he got from Winship doctors and staff were unmatched. “There were many great solutions here in Atlanta, but the best to me was Emory Proton Therapy Center,” says Tony.