Cervical Cancer   

This is not the standard of care in the USA.

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

What dose/fractionation would you recommend?

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

Margins are negative.

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

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

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

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...

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

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

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

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

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

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

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 dose would you use?

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...

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 add an IMRT boost with possibly vaginal brachytherapy?

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

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

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

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

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...

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

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

Does your strategy change if bladder invasion is present?

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