Radiation Oncology

Endometrial Cancer   

Questions discussed in this category


Re-staging is otherwise negative; patient's disease has FIGO grade 1 endometroid histology

In the PORTEC LVSI grading system, 3 or more vessel are classified as extensive LVSI, while the FIGO 2023 Endometrial Cancer staging they reference WH...

Would you consider VBT alone vs EBRT and/or offer chemo? This is a female in her late 60s with FIGO 2023 IIB disease given substantial LVSI+ (>5 v...

What would you recommend for a patient in their 60s with stage IB grade 1 endometrial cancer without LVSI? How would this differ for a patient with st...

How will you translate treatment recommendations from older studies to the new staging system?

A patient in her 70s initially underwent TAHBSO + LNB with Stage I, G1 cancer, No LVSI. 18 months later with very small mucosal recurrence (5mm). HDR ...

This case involves an impressive ‘high volume’ vaginal recurrence and patient was not originally planned for adjuvant therapy. Concerned t...

Would the extent of nodal involvement sway you one way or another (i.e., a micromet in a single sentinel node)?

Do you wait until chemotherapy completion, interdigitate between cycles 1-2 only when feasible, or between any cycle of chemotherapy? What factors wo...

At our institution we often give 5.5 Gy x 4 fractions. There really does not appear to be a general consensus regarding timing. Interested in what oth...

Would there be a survival advantage to pelvis RT with deep myometrial invasion, LVSI and ITC?

What instructions do you give your radiation therapists - do you rely on OAR identification (ie. bladder and rectum filling) or soft tissue match to t...

Do you give cuff and chemo or pelvic CRT or chemo alone?

The patient is >40 yo with Lynch syndrome and a history of endometrial hyperplasia status post R0 TAH/BSO with SLNBx for a 5.2 cm, grade 3 adenocar...

If you do not use the PORTEC-3 regimen for p53 mutated IA endometrial cancer, what specific protocol or combination of chemotherapy and radiation ther...

How do you take into account pathologic factors like %clear cell histology, myometrial invasion, and LVSI?  

Would you recommend if there is only one uterine factor or do you typically require multiple to make this recommendation? 

Please consider this National Cancer Database (NCDB) and Surveillance, Epidemiology, and End Results Program (SEER) registry study (Barrington et al.,...

Female in her 60s who had presented originally with well-differentiated endometrioid adeno clinically and radiographically involving bilateral paramet...

This patient previously received hysterectomy with adjuvant vaginal cuff brachytherapy without pelvic RT. Colonoscopy demonstrated invasive disease, b...

Is there any particular reason to include or not include this in the treatment volumes?

VC brachy, pelvic RT, +/- chemo?  Does your management change if it is confined to the endometrium without myometrium invasion or if it is only ...

EBRT vs VB? She technically meets PORTEC2, but also meets GOG99 and GOG249 (for pelvic RT) and PORTEC4. NCCN recommends for IB grade 1 vaginal brachyt...

Is there any indication for ENI in early stage disease or in advanced stages, without pathologic confirmation or PET positivity or CT size criteria?

The patient was initially observed after radical hysterectomy due to young age, FIGO IA grade 2 disease. The patient had isolated, biopsy-proven vagi...

In women receiving HDR intracavitary brachytherapy to treat the vaginal cuff, how do you overcome the challenge of excess lateral vaginal tissue ("dog...

Planning carboplatin/taxol/trastuzumab. Cervical stromal invasion on path. Looking for pelvic vs brachy and timing with chemotherapy.

Tumor felt to be technically unresectable due to extensive cervical/parametrial involvement. ER/PR and HER2 testing are pending.

Tumor traverses the myometrium to focally involve the serosa; 1/6 sentinels with ITC and the rest negative. 

In the unfortunate setting where you cannot get an underinsured patient whose policy does not cover radiotherapy started on treatment without guarante...

Would you offer EBRT alone or EBRT with vaginal cuff brachytherapy after surgery and chemotherapy for stage III (T3N0) carcinosarcoma of the uterus? ...

For a patient with good response to immunotherapy (unable to receive chemotherapy due to kidney function, comorbidities) where previously avid LN have...

http://abstracts.asco.org/199/AbstView_199_180760.html http://abstracts.asco.org/199/AbstView_199_187537.html  

How do you counsel a pre-menopausal female with endometrioid cancer desiring definitive RT with egg harvesting and IVF for fertility preservation inst...

Insurance authorization for protons is pending, but if the patient cannot have protons would you treat with standard fractionation to ~70Gy or conside...

NCCN recommends brachytherapy plus or minus pelvic RT for surgically staged Grade 1, Stage II patients, but these originally staged IIB patients were ...

For the management of stage II endometrial cancer, NCCN says pelvic RT and/or vaginal brachytherapy.   Do you ever add vaginal cuff boost to pelv...

MRI and cervical biopsy are negative for cervical involvement 

are there any positive or negative synergies from combined megestrol/RT treatment?

At what point would you introduce the discussion of weight management, whether for risk reduction or overall health?

The NCCN recommends either systemic therapy + brachytherapy or pelvic RT + brachy or brachy alone or observation. How do you decide among these option...

For a woman with complete resection of serous intraepithelial carcinoma of the endometrium, would you recommend adjuvant radiation or chemotherapy? Wh...

Current NCCN guidelines suggest that vaginal brachytherapy is optional, and there may be concern for over-treatment locally given competing risk of di...

In what situations is it appropriate to offer observation (rather than VBT) to patients with stage II endometrial carcinoma who have had a radical hys...

For example, in an otherwise intermediate risk localized endometrial cancer (Grade 2, FIGO IB)?

If the post-operative simulation films reveal a significant lymphocele secondary to pelvic lymph node sampling, is it imperative that the entire lymph...

The gyn oncs at my institution sometimes will not perform lymphadenectomy if biopsy indicates low risk disease. Would LVSI as sole adverse risk factor...

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...


Papers discussed in this category


Gynecologic oncology, 2004-03

The New England journal of medicine, 2019-06-13

Int. J. Radiat. Oncol. Biol. Phys., 2005-08-01

Int. J. Radiat. Oncol. Biol. Phys., 1990-02-01

Gynecologic oncology, 2003-12

Int. J. Radiat. Oncol. Biol. Phys., 2014-05-01

Brachytherapy, 2015

Gynecologic oncology, 2007-11

Eur. J. Cancer, 2008 Apr 02

J Clin Oncol,

Gynecologic oncology, 2018-10

Gynecologic oncology, 2014-11

Lancet, 2010-03-06

International journal of radiation oncology, biology, physics, 2018-08-01

Brachytherapy, 2019 Sep - Oct

Gynecologic oncology, 2009-10

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

Gynecologic oncology, 2013-10

Gynecologic oncology, 2013-01

Eur. J. Cancer, 2010 Jul 07

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-07-20

Lancet Oncol., 2019 Jul 22

Gynecol Oncol, 2019 Sep

Cancer Nurs, 2017-04-21

American journal of clinical oncology, 2018-08

Brachytherapy, 2016 Nov - Dec

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2014-10

Practical radiation oncology, 2017

Gynecologic oncology, 2018-08

International journal of radiation oncology, biology, physics, 2017-04-01

Gynecol Oncol, 2017 Aug

J Gynecol Oncol, 2015 Nov 23

Int J Gynaecol Obstet,

Int J Womens Health, 2017 May 02

Radiat Oncol, 2015 Feb 22

Obstet Gynecol,

International journal of radiation oncology, biology, physics, 2014-03-15

Brachytherapy, 2015

Lancet Oncol., 2018 Feb 12

Gynecologic oncology, 2019-04

J Gynecol Oncol,

Gynecol Oncol, 2020 Aug 15

Gynecologic oncology, 2009-10

Lancet, 2008 Dec 16

Am J Obstet Gynecol, 2017 Dec 06

Lancet,

Journal of minimally invasive gynecology, 2016-02-01

Am J Obstet Gynecol, 2020 Jul 18

Cancer, 1987-10-15

The Lancet. Oncology, 2017-03

International journal of radiation oncology, biology, physics, 2004-03-01

Gynecologic oncology, 2015-11

Gynecol Oncol, 2020 May 29

Gynecol Oncol Rep, 2020 Jan 30

World J Surg Oncol, 2017 Jan 10

Practical radiation oncology, 2019

Brachytherapy, 2019 Apr 17

Brachytherapy, 2019

Radiother Oncol, 2020 Nov 05

Pract Radiat Oncol, 2022 Oct 22

Brachytherapy, 2021 Mar 26

Gynecologic oncology, 2019-06

Gynecol Oncol, 2021 Mar 05

Brachytherapy, 2020 Dec 29

Brachytherapy, 2002

Gynecologic oncology, 2014-05

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

Gynecologic oncology, 2019-03

Brachytherapy, 2012

Int J Gynecol Cancer, 2020 Dec 18

N Engl J Med, 2021 Sep 18

N Engl J Med, 2022 Jan 19

International journal of radiation oncology, biology, physics, 2013-01-01

Cancer, 2009-05-15

Gynecologic oncology, 2018-05

Virchows Arch,

Eur J Surg Oncol, 2012 Jun 14

Arthritis care & research, 2018-10

Int J Gynecol Cancer, 2022 Dec 20

J Clin Oncol, 2020 Aug 04

Int J Gynecol Cancer, 2020 Oct 12

Int J Gynecol Cancer, 2021 Jun

J Contemp Brachytherapy, 2020 Feb 28

Gynecol Oncol, 2022 Nov 15

Gynecol Oncol, 2022 Apr 22

Int J Gynecol Pathol, 2003 Jul

Arch Gynecol Obstet, 1988

Int J Gynecol Cancer, 2018 May

Medicine (Baltimore), 2017 May

Turk J Med Sci, 2019 Oct 24

Brachytherapy, 2022 Nov 03

N Engl J Med, 2023 Mar 27

N Engl J Med, 2023 Mar 27

Gynecologic oncology, 2006-10

Int J Gynecol Pathol, 2021 Jul 13

Br J Cancer, 2018 Oct 25

Int J Radiat Oncol Biol Phys, 2023 Mar 08

Gynecol Oncol, 2020 Jul 25

Translational cancer research, 2021 May

Pract Radiat Oncol, 2022 Mar 04

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

Int J Gynecol Cancer, 2021 Sep 07

J Clin Oncol, 2023 Jan 30

Brachytherapy, 2021 Jan 21

Journal of gynecologic oncology, 2020 Nov

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2023 Jul 24

Advances in radiation oncology, 2022 Oct 25

Practical radiation oncology, 2023 Oct 22

European journal of cancer (Oxford, England : 1990), 2015 Jun 03