The standard definitive treatment for locally advanced cervical cancer includes both external beam radiation therapy (EBRT) and brachytherapy. Brachytherapy is necessary to deliver a highly effective dose to the primary tumor: more than 80-85 Gy biologically equivalent dose in 2-Gy fractions (EQD2) can routinely be delivered to the tumor periphery while the central cervix receives even higher doses (>120 Gy EQD2). The ability to safely deliver a high dose to central disease undoubtedly explains the excellent local control rates that can be achieved when cervical cancers are treated with a combination of EBRT and brachytherapy. Recently, Han et al (1) published Surveillance, Epidemiology, and End Results (SEER) data for brachytherapy use in patients treated for cervical cancer in the United States. In that study of 7359 patients who received EBRT between 1988 and 2009, only 63% were also reported to have received brachytherapy. Furthermore, the rate of brachytherapy use fell from 75%-80% in the 1980s and 1990s to <60% after 2003. Importantly, patients who were treated with combined EBRT and brachytherapy had a significantly better overall survival than those treated with EBRT alone (65% and 50%, respectively); there were no significant differences in non-cancer-related deaths between the 2 groups
Exposure to very low levels of ionizing radiation is common—medical procedures, air travel, and industrial processes expose people to such radiation every day. But the health implications of these very low doses are not well understood. A bipartisan bill passed 7 January by the U.S. House of Representatives seeks to alter that landscape by revitalizing an existing Department of Energy (DOE) low-dose radiation research program.
The bill—motivated in part by concerns raised by the Fukushima nuclear disaster in Japan—calls for a study by the National Academies and would require DOE to produce a 5-year research plan. But it doesn’t provide any new funding, and so far the bill doesn’t have a champion in the Senate, which will also to have to pass the legislation in order for it to become law.
RADIATION therapy is a powerful tool for improving the survival rate of those diagnosed with certain forms of cancer. But the dozens of doses of high-energy radiation involved carry a risk, as healthy cells are zapped along with cancerous ones. Many short-term and long-term consequences are well known, including an increased risk of developing new cancers decades after successful treatment. But improvements in early diagnoses, chemotherapy and surgery (as well as, lately, immunology) have combined with radiation to produce larger numbers of cancer survivors living beyond the ten-year mark from the end of treatment. This has brought a previously suspected link into sharper focus: radiation-induced heart disease (RIHD). On July 16th a study called for higher level of cardiovascular screening in cancer survivors. But how can radiation therapy cause heart disease?