TOXICITIES OF PELVIC

RADIOTHERAPY
Dr.Nabeel Yahiya E K
Assistant Professor
Radiation Oncology
Malabar Cancer Centre
INTRODUCTION
• CARCINOMA CERVIX

• CARCINOMA ENDOMETRIUM

• CA BLADDER

• CA RECTUM

• CA PROSTATE

• SARCOMA
ACUTE OR EARLY EFFECTS
• Diarrhoea • Tenesmus

• Dermatitis • Dysurea

• Abdominal pain • Increased frequency

• Nausea • Marrow suppression

• Vomiting
LATE EFFECTS
• Rectum – Bowel

• URINARY

• OTHERS
Rectum – Bowel
• Bleeding PR • Bowel obstruction

• Fistula • Rectal stricture

• Malabsorption • Perforation

• Rectal ulcer
URINARY
• Chronic cystitis

• Bladder ulcer

• Urethral stricture

• Incontinence

• Hematurea
OTHERS
• Vaginal stenosis • Deep Vein Thrombosis

• Subcutaneous fibrosis • Second malignancy

• Leg edema • Myelosuppression

• Infertility • Pelvic fibrosis

• Sexual dysfunction • Bone fractures

HOW TO REDUCE TOXICITY
• High-energy (>6 MV) linear accelerators

• Pelvic field: multiple-field technique (posterior- anterior plus laterals or

posterior-anterior-anterior- posterior plus laterals) is recommended.

• Computerized dosimetry optimizing between minimizing the lateral hot spots

and small bowel dose and increasing the homogeneity within the target
volume

• In thin patients, a combination of 6 MV for the posterior fields and higher-

energy photons for the lateral fields may result in more homogeneous
dosimetry
• Shaped blocks and, if needed, wedges on the lateral fields

• Use small bowel contrast for identifying and shielding small bowel

• Full bladder, only if it does not make the patient so uncomfortable as to cause
movement

• Immobilization molds (belly boards) and abdominal wall compression may be

helpful
• IM-WPRT for pelvic cancers has the potential for better sparing of normal
tissues

• Early studies show lower incidences of morbidities than for conventional 3D-
CRT

• IMRT-based sparing of the iliac crests may also reduce bone marrow toxicity