Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you sequence chemotherapy and radiotherapy for a patient with stage IIIC1 serous endometrial carcinoma?
Update to Recommendation (3/2025): Clinical trial data supports incorporating immunotherapy with chemotherapy in the adjuvant setting for this group of patients. My recommendation for a patient with Stage IIIC1 serous endometrial cancer depends on the HER2 status as follows: HER2+: Chemotherapy + t...
When can brachytherapy be used alone in the definitive treatment of FIGO IA1/IA2 medically inoperable cervical cancer?
Certainly, IA1 patients can be managed with brachytherapy alone, since the risk of LN metastases is very small. Of course, conization is another, simpler, option in selected cases. The use of brachy alone in IA2 patients is more controversial, and one can say that it would not be considered appropri...
In cervical cancer, is the presence of parametrial LNs with ITCs considered parametrial disease requiring adjuvant chemo +/- RT?
Depending on the patient's general condition and performance status, I would consider adjuvant treatment with chemoradiation. In this case, although there was a good pelvic lymph node dissection with 29 negative right and left pelvic nodes, there are positive parametrial nodes with ITC. One could co...
What is your approach to a cervical cancer in a patient with a previous supra-cervical hysterectomy?
I have had 2 patients with this scenario. Given that the primary site of disease remained intact, I chose to treat fundamentally the same as I would otherwise treat an intact cervix. Both were early-stage and underwent CRT with planned insertions intended to limit total treatment length to under 56 ...
How do you manage a cT3bN0 endometrial cancer with large vaginal drop met s/p NAC and TAH/BSO with pCR?
I would offer EBRT plus brachytherapy. Also if distal vaginal mets, would add inguinal nodal region into the volume. If drop mets was not excised, would favor higher brachytherapy dose to the site of vaginal disease (EQ2 of 60 to 70 Gy).
What is your approach for treating locally-advanced gastric-type adenocarcinoma of the cervix?
We still treat with definitive chemo RT (cis) but if operable, then favor surgery first.
In a fit/young patient, how do you manage endometrial cancer with inguinal node involvement that has had favorable response after upfront systemic therapy?
If operable after chemo then surgery followed by adjuvant RT.
Do you give vaginal cuff brachytherapy and/or whole pelvis, for patients with Stage III endometrial adenocarcinoma?
Depends on the substage and extent of surgical staging: Stage IIIa serosa: I give pelvic RT alone often following chemotherapy. I would also add vag brachy in cases of cervical stromal invasion. Stage IIIa adnexae. Same as (1). Stage IIIb. I give pelvic RT plus vaginal brachy often following chemot...
How would you manage a cervical cancer patient with bulky PA LNs with direct extension and/or invasion into the lumbar vertebral bodies?
I would treat with definitive intent. May do chemo IO first and then definitive chemo RT.
What strategies have you found to be most helpful in improving patient compliance with vaginal dilator use after pelvic radiotherapy?
We attempted a randomized feasability trial to a study dilator use and test a theoretically driven enhanced educational program (EEP) to increase adherence, We did not find increased adherence to the EEP program. At present, other than good physician and nursing counselling, I am unaware of signific...