Gynaecological tumours

Specialists in gynaecological tumours care

Led by Prof. Dr. Michael Pinkawa, our radiotherapy team has extensive experience in treating pelvic gynaecological tumours. Radiotherapy at WEGE Klinik is performed by an interdisciplinary team that brings together clinical expertise and personalised care.
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Treatments at WEGE

The appropriate radiotherapy treatments for gynaecological tumours depend on the type, stage, and location of the tumour, as well as whether the goal is curative or adjuvant. At WEGE Klinik, treatment is tailored to each patient using state-of-the-art technology and imaging. 

Gynecological tumours (pelvis)

Gynecological tumours in the pelvis include tumour of the uterus (corpus and cervix), the vagina and vulva. Tumours of the vagina are rarely occurring tumours with an important role for radiotherapy and brachytherapy. Ovarian tumours are commonly treated with radiotherapy only in a metastatic situation.

Radiotherapy is applied as single modality or in combination with a systemic therapy (as chemotherapy and immunotherapy) as definitive treatment (without an operation) or postoperative treatment in case of specific risk factors that require an additional treatment and offer the best possible chances to cure the disease.

Uterine corpus tumour

For the majority of uterine corpus tumours, the resection of the uterus and often also locoregional pelvic lymph nodes is the initial treatment after diagnosis. The decision for postoperative treatment is based on individual factors, including the tumour stage (considering the size of the tumour, invasion of neighbouring tissues or lymph nodes) and specific pathologically determined factors (immune histochemistry and molecular genetics). For low-risk tumours, no postoperative treatment is needed. Patients usually present in WEGE MVZ for the first appointment after recommendation for a specific treatment in a multidisciplinary tumour board. Prior reports and imaging is needed for a detailed assessment and discussion in our MVZ. 

For intermediate risk tumours, vaginal brachytherapy as the only modality is frequently recommended. This is an outpatient treatment that is usually performed in five fractions, with a single fraction per week. For vaginal brachytherapy, an applicator is inserted into the vagina, similar to an intravaginal ultrasound probe. After CT-based three-dimensional treatment planning, a radioactive Iridium-192 source is transferred into the applicator. It remains for a few seconds at precalcualted positions. The treatment duration takes only 3-5 minutes. The patient does not feel any effect during this treatment.

In a high-risk tumour, the risk or tumour spread into pelvic nodes or areas outside the pelvis is increased. Therefore, treatment commonly includes a chemotherapy and an external beam radiotherapy. An external beam radiotherapy implicates the treatment of the vaginal vault and pelvic nodes. The treatment is performed in daily fractions, five days a week, over about six weeks. External beam radiotherapy is applied as a so called volumetric modulated arc therapy (VMAT), delivering the dose during continuous rotation of linear accelerator gantry around the patient and continuous movement of the leafes that are forming the beam from the respective direction.

Cervical tumour

Smaller cervical tumours are rected locally (cone biopsy) or resection of the uterus with pelvic lymph nodes. Depending on individual factors, as tumours size or with tumour spread into pelvic nodes, an additional might be needed. This treatment often includes a combination of external beam radiotherapy, as described above, with a simultaneous chemotherapy.

Gynecological brachytherapy

Standard treatment for tumours extending outside the cervix or uterus or with extension into pelvic nodes is a combined radio chemotherapy (systemic treatment might also include an immunotherapy) and an additional brachytherapy. 

Brachytherapy is based on the placement of a radioactive source (Iridium-192) in the target tissue. In contrast to external beam radiotherapy, the dose is not applied from the outside through the skin and potentially other organs but directly placed in the target tissue. The consequence is the best possible treatment conformality (best focus on a specific area) and the lowest doses to organs as bladder or bowel. Fraction doses in brachytherapy are usually considerably higher and treatment duration considerably shorter in comparison to external beam radiotherapy. 

Brachytherapy is an essential part of cervical cancer treatment. It is only performed in specific specialized centres, as specific expertise is needed for this treatment. Three-dimensional treatment planning is based on a recent MRI and a planning CT with the applicator in place. The applicator is placed intravaginally and into the cervical canal. Commonly, the placement is performed under anesthesia using applicator needles that are placed into the cervical tissue (interstitial needles). Additional placement of the radioactive source into these needles improves the tumour coverage considerably. It is essential to reach an adequate plan quality, as brachytherapy is a crucial part of the multimodal treatment. In most cases, two fractions are applied with the same applicator in place on two consecutive days and additional two fractions in the following week with a second applicator placement. Interstitial brachytherapy is performed during a short inpatient stay at WEGE Klinik. 

Vulvar tumour

An operative resection is the first step in the treatment of vulvar tumours. If resection margins are not adequate or tumour cells detected in lymph nodes (usually inguinal lymph nodes), a postoperative radiotherapy (sometimes radio chemotherapy, radiotherapy combined with chemotherapy) will be often recommended in the multidisciplinary tumour board. The target of the external beam radiotherapy can be the vulva and/or lymph node areas, depending on the individual risk.

If resection is not possible, a primary radiotherapy or radio chemotherapy of the vulvar tumour and locoregional lymph node regions is performed. This is usually an external beam radiotherapy in 30-35 daily fractions, five fractions per week. In selected cases, brachytherapy is applied as a boost to external beam radiotherapy (boost = increased dose in the high-risk macroscopic tumour to increase efficiency). Applicator catheters are implanted in the vulvar tumour under general anesthesia. With the implanted catheters in situ, a planning ultrasound or computed tomography is performed as the basis for three-dimensional treatment planning. During treatment, the radioactive source (Iridium-192) is placed in the vulvar tumour via the applicator catheters. The source remains for a specific time at specific places. These times and places are calculated in the treatment plan to deliver the required dose distribution. The duration of each fraction is about 5-10 minutes. The number of fractions is depending on the individual case (tumour volume, tumour expansion, neighboring tissues/organs).