Radiation Therapy for Uterine Sarcomas

Radiation therapy uses high-energy radiation (such as x-rays) to kill cancer cells. Two types of radiation treatments may used for uterine sarcoma:

  • External beam radiation therapy
  • Internal radiation therapy or brachytherapy.

Sometimes both brachytherapy and external beam radiation therapy are used. How much of the pelvis needs to be exposed to radiation therapy and the type(s) of radiation used depend on the extent of the disease.

Radiation may be used to treat uterine sarcoma in these ways:

  • When the tumor can be seen growing through the cervix, radiation therapy might be used before surgery to make it easier to remove all the cancer.
  • After surgery it may help lower the chance of the cancer coming back in the pelvis. This is called adjuvant radiation. It may be done for cancers that are high grade or when cancer cells are found in the lymph nodes. In these cases, the entire pelvis may be treated with external beam radiation therapy. Sometimes the radiation field will also include an area of the abdomen (belly) called the para-aortic field. This is the area around the aorta (the main artery).
  • It may be the main treatment in a woman who can’t have surgery because of other health problems.
  • It may be used to treat problems caused by tumor growth, but is not intended to treat the cancer. For instance, radiation can be used to shrink a tumor that's causing pain and swelling by pressing on nerves and blood vessels. This is called supportive or palliative care.

External beam radiation therapy

External beam radiation therapy is the more common type of treatment in which a large machine directs the radiation into the body. The treatments are a lot like getting an x-ray.

This therapy is usually given 5 days a week for 4 or 5 weeks. The actual radiation treatment takes less than 30 minutes.

The skin covering the area over the tumor is carefully marked with permanent ink or tiny tattoos. These marks are used to send the radiation to the right area. A special mold of the pelvis and lower back is custom-made to be sure the woman is in the exact same position for each treatment.

Brachytherapy

Brachytherapy places radioactive materials close to the tumor. Women treated with this type of radiation are not radioactive after the implant is removed.

In cases where less than the upper 2/3 of the vagina needs to be treated, the radioactive material is put in through the vagina. This is called vaginal brachytherapy.

Treatment is done in the radiation suite of the hospital or treatment center. About 6 to 8 weeks after the hysterectomy, the surgeon or radiation oncologist puts a special cylinder (applicator) into the woman's vagina. The length of the cylinder (and the amount of the vagina treated) can vary, but the upper part of the vagina is always treated. Pellets of radioactive material are then put into the applicator. Nearby structures, like the bladder and rectum, get less radiation exposure.

There are 2 types of brachytherapy: low-dose rate (LDR) and high-dose rate (HDR).

In LDR brachytherapy, the radiation pellets are usually left in for 1 to 4 days at a time. The patient needs to stay very still to keep the applicator from moving during treatment, so she's usually kept in the hospital on strict bed rest. More than one treatment may be needed.

In HDR brachytherapy, the radiation is more intense. It's given the same way as LDR, but a higher dose of radiation is given over hours instead of days. Because the applicator is in for a shorter period of time, the patient can usually go home the same day. For uterine cancers, HDR brachytherapy is often given daily or weekly for a total of about 3 doses .

Side effects of radiation therapy

Short-term side effects

Short-term or temporary side effects of radiation therapy include:

  • Extreme tiredness (fatigue)
  • Nausea and vomiting
  • Loose stools or diarrhea
  • Skin changes
  • Low blood counts

Skin changes are also common, with the skin in the treated area looking and feeling sunburned. As the radiation passes through the skin to its intended target, it may damage the skin cells. This can cause irritation that ranges from temporary and mild redness to permanent discoloration. The skin may release fluid, which can lead to infection, so care must be taken to clean and protect the area exposed to radiation.

This same kind of damage can happen inside the vagina with brachytherapy. As long as a woman is not bleeding heavily, she can continue to have sex during radiation therapy. But the outer genitals and vagina may become sore and tender to touch, and many women choose to stop having sex for a while to let the area heal.

Side effects tend to be worse when chemotherapy is given along with radiation.

Almost all side effects can be treated with medicines and go away over time after treatment ends. If you're having any side effects from radiation, discuss them with your cancer care team. There are things you can do to get relief from these symptoms or prevent them.

Long-term side effects of radiation

Radiation can also cause some side effects that can last a long time.

Radiation can irritate the bladder and may cause problems with urination. Bladder irritation, called radiation cystitis, can cause discomfort and an urge to urinate frequently.

Radiation therapy might also cause scar tissue to form in the vagina. If the scar tissue makes the vagina shorter or more narrow it's called vaginal stenosis. This can make vaginal sex painful. A woman can help prevent this problem by stretching the walls of her vagina several times a week. This can be done by having sex 3 to 4 times a week or by using a vaginal dilator (a plastic or rubber tube used much like a tampon to stretch out the vagina). Still, vaginal dryness and pain with sex can be long-term problems after radiation. We have more information on how radiation can impact your sex life.

Pelvic radiation can damage the ovaries, resulting in premature menopause. But most women being treated for uterine sarcoma have already gone through menopause, either naturally or as a result of surgery to treat the cancer.

Radiation to the pelvis can impair fluid drainage from the legs, leading to leg swelling. This is called lymphedema. It's more common in women who had lymph nodes removed during surgery.

Pelvic radiation can also weaken bones, leading to fractures of the hips or pelvic bones. It's important that women who have had pelvic radiation contact their doctor right away if they have pelvic pain. Such pain might be caused by a fracture, recurrent cancer, or other serious conditions.

For more information, visit the radiation therapy section of our website.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Annede P, Gouy S, Mazeron R, et al. Optimizing Local Control in High-Grade Uterine Sarcoma: Adjuvant Vaginal Vault Brachytherapy as Part of a Multimodal Treatment. Oncologist. 2017;22(2):182-188.

Lee SW, Lee TS, Hong DG, et al. Practice guidelines for management of uterine corpus cancer in Korea: a Korean Society of Gynecologic Oncology Consensus Statement. J Gynecol Oncol. 2017;28(1):e12.

National Cancer Institute. Uterine Sarcoma Treatment (PDQ®)–Health Patient Version. October 13, 2017. Accessed at www.cancer.gov/types/uterine/patient/uterine-sarcoma-treatment-pdq#section/_56on October 24, 2017.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Uterine Neoplasms. Version 1.2018 -- October 13, 2017. 

Last Medical Review: October 12, 2017 Last Revised: November 13, 2017

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