Radiation Oncology

Cervical Cancer   

Questions discussed in this category


What are your volumes and dose/fractionation for external beam boost in lieu of tandem and ovoid or tandem and ring implant?

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...

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

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...

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

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

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

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

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

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

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

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...

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

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

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

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

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

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

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

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

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

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

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

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

Patient with stage IIB cervical cancer treated 8 years ago, now with large (>10cm), isolated, symptomatic recurrence involving the left SCL and med...

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

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

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

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

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...

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

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

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...

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

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...

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

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...

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...

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

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


Papers discussed in this category


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Seminars in radiation oncology, 2019-04

International journal of radiation oncology, biology, physics, 2006-08-01

Gynecologic oncology, 2005-11

J. Clin. Oncol., 2011 Mar 28

BMC Cancer, 2017 Apr 28

Clin Transl Radiat Oncol, 2018 Jan 11

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2019-01

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Cancer,

N. Engl. J. Med.,

J Gynecol Oncol,

International journal of radiation oncology, biology, physics, 2008-11-15

Int. J. Radiat. Oncol. Biol. Phys., 2012 Aug 14

Practical radiation oncology, 2017

Practical radiation oncology, 2018

Radiother Oncol, 2020 Oct 14

The New England journal of medicine, 1999-04-15

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2000-04

Ann Oncol, 2012 Feb 21

JAMA Oncol,

Int J Gynecol Cancer, 2019 Jan 04

Gynecologic oncology, 1998-08

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2004-08-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-10-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1985-08

Cancer, 1981-08-15

Clin Transl Radiat Oncol, 2020 Apr 16

Pract Radiat Oncol, 2019 Nov

Cancers (Basel), 2021 Mar 11

International journal of radiation oncology, biology, physics, 2017-12-01

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2017-03

N Engl J Med, 2021 Sep 18

N Engl J Med, 2022 Jan 19

Radiother Oncol, 2016 Sep

JCO Glob Oncol,

Gynecologic oncology, 2003-06

American journal of obstetrics and gynecology, 2007-11

Gynecol Oncol, 2022 Oct 15

Am J Surg Pathol, 2015 Nov

BMC Cancer, 2021 Oct 11

Gynecol Oncol, 2019 Jan 29

Int J Gynecol Cancer, 2018 Jan

BMB Rep, 2022 Sep

J Gynecol Oncol, 2019 Sep 17

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2006-03-01

Clinical Medicine Insights. Oncology, 2022 Jun 24

N Engl J Med, 2023 Mar 27

N Engl J Med, 2023 Mar 27

Int J Gynecol Cancer, 2021 Sep 07

Gynecologic oncology, 2004-03

The New England journal of medicine, 2018-11-15

J Clin Oncol, 2023 Jan 30

Gynecol Oncol, 2021 Sep

Rheumatology (Sunnyvale, Calif.), 2015 May 07

Annals of the rheumatic diseases, 2013 Jul 10

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2022 Mar

International journal of radiation oncology, biology, physics, 2023 Jan 12

The Lancet. Oncology, 2023 Dec

The Lancet. Oncology, 2021 Apr

International journal of radiation oncology, biology, physics, 2024 Oct 23

Int J Radiat Oncol Biol Phys, 2020 Mar 1

Radiation oncology (London, England), 2021 Jun 14

Seminars in radiation oncology, 2016-04

Advances in radiation oncology, 2017

Gynecologic oncology, 2019-03