Cervical Cancer

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

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

Would you consider SBRT or brachytherapy?

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

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

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Do you offer ovarian transposition to premenopausal cervical cancer patients prior to chemoradiation therapy? What factors affect this decision?

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

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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...

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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...

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

This is not the standard of care in the USA.

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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?

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

What dose/fractionation would you recommend?

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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.

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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?

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

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

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

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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 ...

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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 ...

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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...

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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...

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

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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...

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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?

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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?

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

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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?

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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?

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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?

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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?

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

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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?

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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...

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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?

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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?

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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?

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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...

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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?

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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?

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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...

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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 ...

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

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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?

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

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

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Are there instances where you prefer a 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?

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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?

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

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

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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?

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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...

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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...

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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?

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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...

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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...

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When do you transfuse cervical cancer patients undergoing chemoradiation?

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

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

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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.

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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?

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