The Royal College of Radiologists’ latest gynaecological cancer statements have been published, with input and support from radiographers and radiotherapy teams.
The Royal College of Radiologists (RCR) has published its consensus statement on gynaecological cancer, as part of efforts to support clinicians in “controversial” areas of practice that lack strong evidence.
Its latest consensus statement covers five topics, providing guidance for the usage of:
- Image-guided and adaptive radiotherapy (IG-ART) for mobile gynaecological targets
- Brachytherapy
- Imaging and follow-up including late effects
- Reirradiation of gynaecological cancers
- Molecular testing and sentinel lymph node assessment in endometrial cancer
The statement suggests effective processes and techniques for treatment preparation, delivery, training, and quality assurance, as well as imaging.
Advice and guidance
In particular, with regards to the imaging of gynaecological cancers, it advised radiographers to:
- Offer post-treatment imaging to assess radiological response and facilitate detection of salvageable recurrence if appropriate
- Offer MRI at three months post-treatment and consider positron emission tomography-computed tomography (PET-CT), and to consider interval MRI imaging for cancer that is regressing but has not resolved at the three-month scan
- Offer PET-CT if residual or progressive disease on MRI and a radical surgical option is available and appropriate
- For early detection of locoregional recurrence consider MR imaging of the pelvis, plus retroperitoneum if appropriate, at one year
- For early detection of oligometastatic disease, offer CT imaging at one year and consider additional imaging beyond one year
This statement was developed through consultation with Therapeutic Radiographers, clinical oncologists, medical physicists, a gynaecological oncologist, a radiologist and a senior programme manager from Living With & Beyond Cancer at NHS England, and a Pelvic Radiation Disease Association trustee.
The group was asked to focus on topics where there was current variation in the UK.
Previous RCR audits and surveys in gynaecological cancer have shown variation in practice across the country decreased following introduction of its national recommendations.
Development of the statement
The group focused on topics which reflect challenges within gynaecological cancer in the UK, with a significant national variation in available technology, technical expertise and post-treatment care. It also focused on areas where decreasing variation or introducing different techniques or approaches are likely to lead to the greatest benefit to patients, either in survival and cure or in quality of life after treatment.
The RCR advised: “The gynaecological cancer consensus statements should serve as a practical stimulus for gynaecological cancer teams to review their current radiotherapy service to ensure that they are able to deliver optimal treatment for their patients. They should be adopted in parallel with relevant National Institute for Health and Care Excellence (NICE) guidance.”