Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What lessons can we learn from RTOG 0418 in how to best use IMRT to treat endometrial cancer?
Despite an atlas and detailed instructions, there were still problems noted with contouring. I think the most important lesson is the need for careful contouring and the use of an ITV comprised of a fusion of full and empty bladder scans. I encourage people to place patient’s on RTOG 1203 – which ra...
Once endometrial cancer recurs after no chemo or XRT, is it curative or palliative?
It depends on where the recurrence is. if it is a pelvic recurrence in the vagina or a nodal recurrence in the pelvis or PA region, then the goal of treatment is curative, although the salvage rate is much higher for vaginal recurrences than for nodal recurrences. The salvage rate is also a function...
Would you include a lymphocele in your IMRT treatment volumes for endometrial carcinoma?
We only include the lymphocele is there is a positive node in the area of the lymphocele. If the nodes are not positive in the area of the lymphocele - we do not include the entire lymphocele.
How do you define and IR-CTV for cervical brachytherapy?
Since most outcome data based on HRCTV dose , I don't routinely contour or monitor dose to IRCTV for cervical cancerhttps://www.ncbi.nlm.nih.gov/pubmed/30605752
How successful is IVF after definitive radiation therapy to the pelvis for endometrial cancer?
The most extensive data regarding the effects of uterine RT are for pre and peri-menarchal girls. Although women who had pelvic RT as children can often become pregnant if the ovaries are still functional, even doses as low as 10-20 Gy cause atrophic development of the uterus with decreased uterine ...
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?
Patients usually have radical hysterectomy, so repeating surgery is not an option for most cases. I may recommend vaginal cuff brachytherapy in this case.
What adjuvant therapy would you offer a patient with Stage II uterine serous carcinoma without lymph node sampling?
Since the major concern for UPSC is distant mets, these patients typically first receive 6 cycles of carboplatin/taxol after surgery at our institution. If the patient tolerates it without significant toxicity and re-staging scans are clear, we would then offer whole pelvis RT (45 Gy in 25 fractions...
For patients with endometrial recurrence of vaginal vault/pelvis, who are not candidates for brachytherapy boost, what external beam boost dose have you used following pelvic EBRT?
It’s unusual not to be able to do brachytherapy but sometimes for side wall/parametria recurrences that are not accessible, can deliver 66-70 Gy based on OAR tolerance.
What is the optimal approach for a younger female with borderline resectable cervix cancer who may need adjuvant radiation, in light of a medical history significant for ulcerative colitis?
It all depends on the colitis status on therapy including the extent and response to ongoing treatment. No induction chemo. Either radical hysterectomy with the possibility of adjuvant RT or definitive RT based on colitis status. If high risk with RT, would proceed with surgery.
What is your protocol for conscious sedation during T&O insertion?
I have used many forms of anesthesia for cervix HDR and all have some disadvantage. For the last couple of years I have moved to spinal anesthesia which has been ideal for our workflow. Patients receive a single dose of bupivicaine via CRNA/anesthesia team in our in brachy suite. The provides about ...