Cervical Cancer&nbsp;&nbsp;&nbsp;

If a patient meets criteria for extrafascial hysterectomy for early-stage cervical cancer, how do you determine your surgical approach (abdominal vs laparoscopic)?

Would you offer post operative radiation for a patient who had findings of lymphovascular invasion on salvage resection of a recurrent obturator node after definitive chemoradiation for cervical cancer?

That nodal region has previously received 55 Gy in 25 fractions.

Now that the INTERLACE trial is published, do you plan to do induction chemotherapy prior to chemoRT or chemoRT with immunotherapy (per KEYNOTE-A18) for locally advanced cervical cancer?

How would you manage a cervical cancer patient with bulky PA LNs with direct extension and/or invasion into the lumbar vertebral bodies?

Would you consider this stage IVA (spread to adjacent organ) or IVB (spread to distant organ)? For instance, would the presence of direct lumbar verte...

What are your top takeaways from SGO 2022?

10 Answers available

Do the results of the ConCerv and SHAPE trials alter how you might counsel a patient incidentally found to have ≤IB1 after simple hysterectomy?

Would you still discuss the option of parametrectomy/upper vaginectomy if they would have met the criteria for SHAPE?

What post-treatment surveillance strategy do you employ for patients who undergo conservative fertility-sparing surgery for early-stage cervical cancer?

Do you recommend completion hysterectomy after completion of child-bearing?

In the context of the ConCerv and SHAPE trials, how would you approach a patient with endometrioid adenocarcinoma within an excised 1.2 cm cervical polyp (negative for LVSI) who has no suspicious lymph nodes on CT scan?

How would you manage a young, healthy patient s/p open radical hysterectomy/bilateral salpingectomy/ovarian transposition/bilateral SLND with now stage IB3 HPV-dependent adenosquamous cervical carcinoma?

Pre-op stage was IB2, but post-op: tumor 4.5 cm, negative margins, no LVSI, 6/15 mm depth of stromal invasion, negative SLN.

How would you manage a female in her 40s with stage III cervical cancer with hydronephrosis and Crohn's disease?

Would you consider standard definitive chemoRT (EBRT + HDR brachytherapy)?

How do you manage a patient with cervical cancer who has FDG uptake in bilateral ischial tuberosities with lytic areas on CT correlate, and also has a history suspicious for untreated polymyalgia rheumatica with chronic symptoms in the same anatomic locations?

Cervical cancer FIGO stage IIIC2. Bloodwork shows elevated ESR and CRP.

In light of the SHAPE trial results, how would you manage a patient with an incidentally diagnosed FIGO IA1 cervical cancer after simple extrafascial hysterectomy/BSO?

No LN dissection was performed as it was for a suspected CIN III. Final pathology showed +LVSI, -margins (>10mm), -parametrial extension, and 1.2mm...

How would you manage a recurrent cervical cancer previously treated with vaginal cuff brachytherapy and has had a complete response to chemo-immunotherapy?

The 4 cm cuff recurrence occurred 3 years after definitive treatment with hysterectomy and vaginal cuff brachytherapy to 21 Gy. The recurrence had a c...

Do you utilize GCSF during pelvic chemoradiation therapy for cervical cancer or avoid it due to concern for paradoxical neutropenia from concomitant radiation + GCSF?

What is your practice when you have a neutropenic cervical cancer patient undergoing chemoradiation?

Given the results of KEYNOTE-A18, do you plan to recommend adding pembrolizumab to primary chemoradiotherapy for advanced stage cervical cancer?

If so, will you recommend it universally or only for certain patient population(s)?

What treatment would you offer a patient with metastatic cervical cancer to the supraclavicular nodes with a complete clinical response in her nodes, but a 3 cm residual in the cervix?

Are there instances where you prefer an SBRT boost rather than a brachytherapy boost when treating definitive locally advanced cervical cancer?

If so, what dose/volume is prescribed? How do you account for motion?

What are your top takeaways from SGO 2023?

7 Answers available

Will you be changing your management of locally advanced cervical cancer based on the results of the recently published INTERLACE trial?

In a patient with previous cervix cancer treated with surgery and adjuvant EBRT who presents with recurrent HGSIL, status post vaginectomy, would you consider brachytherapy?

This is a patient in her 70s who previously received 5040 cGy adjuvant EBRT alone to the pelvis.

Is there a role for chemotherapy and/or vaginal cuff boost to EBRT in FIGO IB1 cervical adenocarcinoma, status post total hysterectomy?

Aside from limit due to extent of her hysterectomy, the patient's disease does not otherwise satisfy Peters' criteria

5 Answers available

When treating stage IVB cervical cancer with both systemic chemotherapy and local pelvic radiation therapy, do you incorporate the use of bevacizumab as in GOG 240?

Consider treatment of stage IVB cervical cancer with systemic therapy and local pelvic radiation therapy as in Perkins et al., PMID 31810653.

Do you have cut off values for neutrophil and platelet counts when doing interstitial brachytherapy for cervical cancer?

Do you recommend the HPV vaccination for your young patients with HPV-associated cancers or pre-cancers who have not yet been vaccinated?

Assuming patient is <45 years old with cervical, vulvar, vaginal, anal, or head/neck cancers, or with CIN/VIN/VaIN/AIN/oropharyngeal precancerous l...

How do you treat cervical cancer with an ovarian metastasis?

Considering this is stage IV disease, do your recommendations for definitive or adjuvant treatment (after surgery) change?

What brachytherapy regimen would you use for a patient who completed only the EBRT portion of their planned definitive chemoradiation course for locally advanced cervical cancer, who is now presenting with persistent/recurrent local disease?

Do you offer adjuvant treatment for patients with early-stage cervical cancer and isolated tumor cells identified in sentinel lymph nodes, if they would otherwise not meet criteria for adjuvant radiation therapy?

What is the optimal approach for a younger female with borderline resectable cervix cancer who may need adjuvant radiation, in light of a medical history significant for ulcerative colitis?

MRI pelvis shows a 3.5 cm primary that appears infiltrative and without clear parametrial extension on MRI. Staging PET negative. Is there any ...

What are your top takeaways in Gynecologic Cancers from ASCO 2023?

After presentation of the SHAPE trial at ASCO, would you consider offering a simple hysterectomy with pelvic LN dissection for early stage cervical cancer <2cm?

If yes, would you consider a minimally invasive approach despite the LACC trial results? If no, what additional research/information is needed to cha...

When do you use a brachytherapy vaginal cuff boost in postoperative cervical cancer treatment?

Close but negative radial margins? LVSI? What fractionation/dose do you use for your vaginal cuff boost if used?

When would you offer extra-fascial hysterectomy to patients with low-risk early-stage cervical cancer in light of data from the ConCerv trial?

ConCerv trial: Schmeler et al., PMID 34493587

What is your treatment approach for an adenoma malignum of the cervix?

7 cm tumor limited to the cervix with no vaginal or parametrial invasion on exam and not lymphadenopathy or metastatic disease on imaging. Cystoscopy ...

How would you treat a woman who has had a simple, extrafascial hysterectomy for a clinically occult, pathologically FIGO stage IB1 cervical cancer?

Occult IB1 cervical SqCC found on simple extrafascial hysterectomy, with 4 mm deep stromal invasion and LVSI. Subsequent pelvic and para-aortic nodal ...

What dose and OAR constraints you use for boost with IMRT or SBRT when a patient with cancer of the cervix is not candidate for brachytherapy?

Could you discuss how you decide between IMRT or SBRT boost for a patient who is not able to receive intracavitary or interstitial HDR or LDR brachyth...

How do you approach adjuvant treatment for node positive high grade gastric type endocervical adenocarcinoma following radical hysterectomy?

When would you use 5-fluorouracil instead of, or in addition to, cisplatin during chemoradiation?

What is your approach for treating locally-advanced gastric-type adenocarcinoma of the cervix?

When would you use 5-fluorouracil instead of, or in addition to, cisplatin during chemoradiation? When, if ever, would you offer adjuvant hysterectomy...

5 Answers available

What is the longest interval to proceed with brachytherapy boost for cervical CA after EBRT?

Ideally, treatment should be completed in 56 days (preferably < 50 days). If there has been a significant delay to brachytherapy (>2-3 months) d...

How would you treat a patient with synchronous locally advanced cervical and ovarian cancers?

Would you offer brachytherapy for a patient with metastatic cervical cancer s/p 30Gy/10 fx to the pelvis followed by chemotherapy who only has isolated disease in the cervix?

If a patient presents with metastatic disease (by virtue of extensive PA nodal burden, mediastinal/SCV involvement, no solid organs) but received urge...

What is your approach to first line systemic therapy in metastatic PD-L1 positive cervical cancer?

Do you include pembrolizumab with platinum-taxane + bevacizumab or reserve it as a second line option?

For gyn cancers receiving chemoradiation, how high can you boost grossly positive nodes with SIB if not near bowel?

SIBs of 55-57.5 Gy in 25 fractions are frequently mentioned with bowel volume constraints at this dose, but assuming there is no bowel nearby (e.g., b...

Would you give additional radiation for a positive margin after salvage hysterectomy for a patient with cervical cancer who had initial definitive chemoradiation with EBRT+T&R?

Would you consider additional EBRT or vaginal cuff HDR in a patient with previous tx with EBRT (45Gy) + HDR (30Gy) for a R1 resection with a radial ma...

What is the role of uterine artery embolization (UAE) in patients with locally advanced cervical cancer with emergent bleeding that persists through vaginal packing?

What are the pros and cons of using uterine artery embolization with regard to how it may affect the efficacy of radiation (+/- chemotherapy)?

Do you offer surgery for patients with early stage cervical cancer who you suspect will need adjuvant radiation regardless of surgical pathology results?

Are there any criteria you use to preferentially recommend primary chemoradiation instead of primary surgery?

How would you approach treatment for a locally advanced cervical cancer in the context of a completely prolapsed uterus in a non-surgical candidate?

How does your approach to the primary treatment of glassy cell carcinoma of the cervix differ from the primary treatment of squamous cell or adenocarcinoma of the cervix?

How do you proceed after a patient has a partial response following 6 cycles of cisplatin + paclitaxel + bevacizumab +/- pembrolizumab for metastatic SCC of the cervix?

Assuming minimal toxicities except fatigue from long, recurrent infusions.

Would you modify standard WPRT+brachy radiation for cervical SCC s/p negative nodal staging but aborted hysterectomy due to previously undetected superficial vaginal disease?

How would you treat an isolated para-aortic node recurrence 1.5 years after receiving primary chemoradiation for locally advanced cervical cancer?

What type of DVT/PE prophylaxis do you employ for an outpatient cervical brachytherapy?

How do you address extended break from EBRT during cervical cancer treatment?

Do you increase EBRT or brachy dose by a certain amount based on interval?

How do you integrate ophthalmic exam and surveillance into routine visits for cervical cancer patients receiving tisotumab vedotin?

What is your approach to a patient with locally advanced cervical cancer who presents with a fistula (rectal or bladder)?

Do you recommend upfront diversion? Are there unique planning considerations such as the inability to use bladder filling? How do you boost? What are ...

For newly diagnosed advanced cervical cancer, how soon after periaortic lymph node evaluation do you start definitive chemoradiation treatment?

Assuming the nodal assessment is minimally invasive and the patient is otherwise healthy without postoperative complications.

How would you treat cervical stump SCC involving bladder, pelvic nodes, and port-site metastasis in a patient post-laparoscopic hysterectomy?

What is your preferred management for a patient who was treated with definitive chemoradiation for locally advanced cervical cancer who now has a biopsy-proven isolated brain metastasis 5 years later?

Consideration for localized therapy alone vs. localized therapy + systemic chemotherapy.

How do you manage a screening pap smear result of HSIL and HPV16+ in a first trimester pregnancy?

What adjuvant therapy do you recommend for early stage poorly differentiated small cell neuroendocrine carcinoma of the cervix after surgical resection?

What impacts your decision to use PET vs CT for radiographic staging of clinically locally advanced cervical cancer?

For a patient with cervical cancer s/p chemoRT, would you consider brachytherapy to downstage tumor to allow for hysterectomy rather than pelvic exenteration?

What is your fertility-sparing management of a stage IA1 cervical squamous cell carcinoma following a LEEP with negative margins and focal LVSI?

When do you transfuse cervical cancer patients undergoing chemoradiation?

Do you try to keep Hb> 10 or 12? Or somewhere in between?

When do you consider re-irradiating patients with recurrent cervical cancer?

What dose fractionation would you use on a large retroperitoneal recurrence of cervical cancer that is extending to previously treated 5040cGy pelvis?

What is your strategy for treatment of FIGO IIB cervical cancer in a patient who poorly tolerated the first insertion and refuses subsequent insertions?

Patient is 38yo, has a history of narcotic abuse, and may have an undiagnosed personality disorder.

What is your approach to a cervical cancer in a patient with a previous supra-cervical hysterectomy?

What palliative regimen do you use for intra-pelvic recurrence of cervical cancer after definitive chemoRT with T&O brachytherapy?

Is the QuadShot a possible option?

What is your institutional protocol for an incidental finding of an adnexal cyst on CT simulation for cervical cancer?

Could EBRT lead to rupture of the cyst?

Would one expect any significant response of pulmonary metastases with usual dosage of weekly cisplatin during definitive chemoRT for cervical cancer?

This patient has pulmonary nodules that are too small to characterize.

How would you manage a patient with 1B2 adenocarcinoma of the endocervix s/p TAH/BSO who was found to have bilateral metastasis to Fallopian tube, a 1 cm pelvic side wall metastasis, and no LN metastasis?

In what scenario would you give consolidation chemotherapy after chemoradiation for stage 3 cervical cancer with a good response?

Would you offer any adjuvant therapy for cervical cancer following total pelvic exenteration in the setting of a positive pelvic lymph node?

Previously received pelvic EBRT and intracavitary brachytherapy. IORT was administered to the node-positive side wall at the time of exenteration.

How would you proceed after complete response to carboplatin/paclitaxel/bevacizumab in a patient who presented with distantly recurrent SCC of the cervix?

Initially treated with definitive chemoRT but recurred with distant mets. Completed 6 cycles carb/tax/bev with minimal toxicity. Excellent performance...

How would you manage a patient with history of locally advanced SCC of the cervix, treated with definitive chemoRT, found to have new lung lesions 6 months post treatment?

Lung is biopsy proven met cervix, SBRT is planned.

What would be your treatment approach for a patient with a new PET positive para-aortic node 3 months following completion of definitive chemoradiation for locally advanced cervical cancer?

Patient did not previously receive para-aortic radiation. Considering RT vs RT + chemo vs chemo alone

How would you approach treatment for centrally recurrent cervical SCC with positive margins after excision that was not exenteration?

Recurrence was 2cm and PET confirmed local. Excision with positive margins. Current plan for salvage whole pelvic RT and vaginal cuff brachytherapy +/...

Do you add chemotherapy to salvage EBRT/brachytherapy for a pt with small vaginal cuff recurrence of cervical CA s/p hysterectomy?

What chemotherapy regimen would you utilize for a metastatic, poorly differentiated carcinoma of the cervix with neuroendocrine features?

If confirmed neuroendocrine and PD-L1 pending, how would you treat?

In cervical cancer, is the presence of parametrial LNs with ITCs considered parametrial disease requiring adjuvant chemo +/- RT?

In patient with PD SCCA 15mm transverse; 5/20mm invasion; LVSI focally present; margins negative; 0/15 Left pelvic and 0/14 right pe...

How do you plan urgent radiation therapy for vaginal bleeding caused by locally advanced cervical cancer?

What dose and technique do you use and how do you integrate the subsequent definitive treatment plan?

When would you consider sequential chemotherapy and radiation rather than concurrent for early stage cervical cancer with high risk pathologic features?

The recently released STARS phase 3 RCT found improved DFS, decreased distant recurrence, with reduced toxicities for chemotherapy (cisplatin + taxol)...

Do you ever offer minimally invasive surgery for treatment of early stage cervical cancer?

Despite the LACC trial, this year's SGO had many posters and discussions around MIS for early cervical cancer. If you offer MIS, what are the key ele...

How would you treat/counsel a patient with Stage IB3 SCC of the cervix who is 18 weeks pregnant and desires to maintain pregnancy?

Would you consider robotic lymph node dissection and parametrectomy for a patient with incidental stage 1A2 cervical cancer after simple hysterectomy?

Margins negative, no LVSI, PET/CT negative.

How would you manage a cervical cancer patient who develops new oligomet to the spine during primary cis/RT?

How would you factor in a patient with profound thrombocytopenia?

How would you approach radiation in a patient with IIIC2 SCC of the cervix with a history of ileoanal reanastomosis and j pouch?

Paraaortic nodes positive to left renal vein

What is your preferred treatment regimen for locally advanced (IIB-IVA) high-grade neuroendocrine carcinoma of the cervix (small cell type)?

Would PET-positive pelvic or paraaortic lymph nodes change this recommendation?

How would you approach nodal assessment in a pregnant patient with new diagnosis of at least stage IB1 cervical SCC?

Currently 7 weeks pregnant, diagnosis based on CKC

Would you offer definitive RT to a patient with metastatic cervical adenocarcinoma s/p carbo/taxol/avastin with a partial response in the metastatic sites?

ex. in a patient with pulmonary micronodules, inguinal, pelvic, PA nodes

How would you approach a diagnostic excisional procedure for a pregnant patient with exam concerning for carcinoma and cervical biopsies (x 2) suspicious for foci of invasive disease?

Patient is currently 7 weeks GA with 1.5cm visible lesion. MFM recommends 13wk CKC vs LEEP with cerclage at that time.

When can brachytherapy be used alone in the definitive treatment of FIGO IA1/IA2 medically inoperable cervical cancer?

When do you include the mesorectum for definitive cervical cancer patients getting concurrent chemoradiation followed by brachy?

Particularly with IMRT when delineating volumes.

Under what circumstances (if any) would you offer hysterectomy after completion of primary chemoradiation for locally advanced cervical cancer?

Would you consider fertility-sparing management of stage IB1 cervical cancer using NACT followed by conization?

Lesion measures 2cm and PET is otherwise negative.

How would you approach unresectable pelvic side wall recurrence in cervical cancer with previous definitive chemoradiation?

Would you consider SBRT or brachytherapy?

Do you sample radiologically negative paraaortic nodes in cervical cancer patients with clinically positive pelvic nodes prior to initiating primary chemoradiation?

What clinical factors would lead to utilizing a tandem and cylinder rather than tandem and ovoid for cervical cancer brachytherapy?

Do you offer ovarian transposition to premenopausal cervical cancer patients prior to chemoradiation therapy?

What factors affect this decision?

In patients with metastatic/persistant/recurrent cervical cancer who have completed platinum-based chemotherapy with bevacizumab, do you offer maintenance bevacizumab?

How do you manage bladder fullness during cervical T&O brachytherapy to minimize OAR dose?

Small bowel is usually the dose limiting OAR while planning cervical HDR brachytherapy. Having the bladder empty during treatment planning and deliver...

When, if ever, would you recommend hysterectomy after chemoradiation for patients with locally advanced cervical cancer?

This has been a common practice in the community. Is there a benefit for certain patients?

Would you consider modifying T&O fractionation during the COVID-19 pandemic?

What dose/fractionation would you recommend?

What are your next steps in management for a patient with endocervical adenocarcinoma s/p radical trachelectomy with a positive pelvic lymph node noted on final pathology?

Margins are negative.

In what situations would you perform a sentinel lymph node biopsy for cervical cancer?

Do you routinely discuss HRT with patients that have undergone surgical menopause due to treatment of cervical cancer?

For an non-operative patient with IB1 cervical cancer, would you recommend RT alone or concurrent chemoRT for definitive therapy?

How would you manage a small posterior vaginal defect noted at the time of cervical brachytherapy?

Patient being treated for cervical cancer noted to have a < 1 cm posterior vaginal fornix defect with a small focus epiploclia herniating into the ...

Would you recommend adjuvant radiation for well-differentiated gastric-type adenocarcinoma of the cervix, stage 1b without LVI?

The limited data on MDA (minimum deviation adenocarcinoma) suggests it has a worse prognosis, but it is hard to disentangle this from stage, as it is ...

Would you consider a single insertion HDR scheme for T&O brachytherapy (BID fractionation over 3 days)?

Would there be a substanital increase in the risk of toxicity using such a scheme? We frequently have patients who have to travel long distance...

How do you choose 1st line therapy for recurrent cervical cancer?

Would you be more or less likely to use a cisplatin-containing regimen if a patient had previously responded to chemoradiation with concurrent cisplat...

How do you determine which systemic therapy to recommend in the 2nd line setting for metastatic, PD-L1 NEGATIVE cervical cancer?

How would you approach treatment for a primary carcinosarcoma of the cervix with pelvic and para-aortic nodal involvement?

What chemotherapy and sequencing with radiation therapy would you recommend? IS surgery a component of the treatment?

Is pembrolizumab considered standard of care in the 2nd line treatment of recurrent cervical cancer?

Does the phase II KN-158 provide sufficient evidence to change management?

Would you recommend 1st line pembrolizumab for PD-L1 positive recurrent/metastatic cervical cancer patient who is not a candidate for or refuses chemotherapy?

When do you recommend PD-L1 testing for patients with recurrent cervical cancer?

Should this be done at the time of recurrence or after failure of 1st line therapy for recurrence?

In a pre-menopausal female with cervical cancer, would you boost a hypermetabolic ovary on PET?

Do you have an SUV cutoff for physiologic activity of the ovary?

For stage IB1 cervical cancer s/p surgery with only 1 Sedlis criteria, should adjuvant pelvic EBRT or vaginal cuff brachytherapy be recommended in the presence of other adverse pathologic features, such as high tumor grade or very close but negative margins?

Would you use different EBRT field edge for an HIV positive patient with FIGO IIIC1 (2018) cervical cancer with positive bilateral external iliac nodes?

Do you cover common iliac nodes (L3/L4) or keep field edge at L4/L5 to reduce bone marrow toxicity?

Are you using the new FIGO 2018 staging or waiting until it is incorporated into the next AJCC edition?

In light of the ongoing GOG 263 trial, do you consider adding concurrent chemo with RT for early stage cervical cancer as adjuvant after Rad Hyst off trial?

If so, what indications would you use other than Peters criteria?

How do you define and IR-CTV for cervical brachytherapy?

Do you use a trimmed 10 mm expansion on HR-CTV? Do you also include the entire initial extent of disease? How much does your IR-CTV coverage affect yo...

What volumes would you use for salvage radiation in a patient with a pelvic lymph node recurrence of cervical cancer initially treated with surgery alone?

What dose would you use?

How do you match a para-aortic field to a previously irradiated whole pelvis field in a woman with PA nodal failure after definitive chemoRT for cervical cancer?

How do you counsel a cervical cancer patient s/p definitive chemoRT who is not sexually active and refuses to use vaginal dilators to improve compliance?

How would you treat an isolated port recurrence of an early stage cervical patient s/p WLE?

A literature search indicates that most port site recurrences are managed fairly aggressively with chemoRT or RT doses 45-66 Gy. This is understandabl...

How do you sequence vaginal cuff brachytherapy with EBRT for post-op endometrial or cervical cases that require both modalities?

Sequentially or do you integrate the cuff brachy with the EBRT and if so what schedule, BIW, weekly, etc?

How do you best manage bulky, clinical stage IIA squamous cell cancer of the cervical stump in a patient with a previous partial supra-cervical hysterectomy?

Would you consider BID treatment for a patient with a pelvic SCC (e.g. cervix or anal) if a significant amount of treatment days have been missed?

For example, a patient with cervical or anal SCC who has missed many treatments due to side effects, low blood counts, hospitalizations, or non-compli...

Do you take patients off anticoagulation for tandem and ovoid or tandem and ring procedures?

What is your approach to a cervical SCC patient in which you're unable to properly place a T&O, due to obliterated cervical os, after completion of EBRT?

Do you add an IMRT boost with possibly vaginal brachytherapy?

What is your protocol for conscious sedation during T&O insertion?

What are your specific protocols for monitoring and for dosing narcotics and sedatives?

How would you approach the management of a patient with locally advanced cervical cancer as well as synchronous endometrial adenocarcinoma?

What strategies have you found to be most helpful in improving patient compliance with vaginal dilator use after pelvic radiotherapy?

What pelvic fields do you treat for patients with FIGO IA2-IB cervical cancer patients who inadvertently get a simple hysterectomy but with lymph node sampling (for presumed endometrial carcinoma)?

In the setting of a negative lymph node sampling, would you treat a full pelvis or mini-pelvis to compensate for lack of the appropriate surgery? Is a...

Do you recommend adjuvant pelvic RT for Stage 1 cervical adenocarcinoma?

In patients who don't meet traditional criteria for adjuvant chemoradiation from Peters (GOG 109) and < 2 high risk factors from Rotman (GOG 92) fo...

What is your technique to calculate the vaginal surface dose in gyn intracavitary brachytherapy?

What exactly do you contour and what is your dose constraint to that volume?

What is the role of parametrial and pelvic side wall boosts in the setting of volumetric brachytherapy for locally advanced cervical cancer treated with either 3DCRT or IMRT?

Does using something like a vienna applicator allow you to avoid dose escalation with more external beam? How do you recommend doing a classic pa...

What are you posterior field borders for endometrial and cervical cancer 3DCRT plans?

Some classic references recommend the coverage of the entirety of the sacrum but the volume delineation guidelines for both seem to only cover the mos...

What is your strategy to deliver EBRT, brachytherapy, and a parametria/lymph node boost in less than 7-8 weeks for cervical cancer?

What small bowel dose constraints do you use in gyn brachytherapy?

The most recent ABS guidelines don't discuss a dose constraint for the small bowel.

If a patient with locally advanced cervical cancer cannot receive brachytherapy following 45Gy to the whole pelvis, how do you optimally deliver your boost?

Does your strategy change if bladder invasion is present?

What indications do you use to prophylactically treat para-aortic lymph nodes in cervical cancer?

Do you treat PAs if pelvic nodes are positive? If common iliacs are involved? Only if there are positive PA nodes?

What is the biggest mistake people make when using IMRT to treat cervical cancer?