Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you treat a locally advanced cervix cancer in a patient who declines brachytherapy?
You provide this lady with a curable disease the appropriate social support, mental health support, and transportation coordination in order for her to complete curative treatment with brachytherapy. Anything short of that in America with all our incredible resources and care options is substandard ...
What clinical and pathological factors guide your decision making when considering whether to recommend vaginal cuff brachytherapy following TAH/BSO for a FIGO stage IA or IB endometrial carcinoma?
The most important risk factors for vaginal wall recurrence for endometrioid adenocarcinomas are grade, depth of invasion and presence of lymphovascular invasion. Now that stage IA includes endometrium only and up to 50% myometrial invasion, it is important to consider the other risk factors. I usua...
How would you treat a patient with a FIGO G1 pT1bN0 endometrial adenoCA involving the lower uterine segment with >50% invasion and a separate focus of disease found involving the endocervical mucosa with no cervical stromal invasion?
Brachy alone as mucosal involvement would not change my management.
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?
Assuming a PET is done, we treat one nodal region above the involvement (the entire common illiac nodes for pelvic only and paraaortic for common illiac involvement) along with vagina and paravgina with concurrent cisplatinum. The dose to involved node is 55 Gy in 25 fractions (equivalent to 58-60 G...
When, if ever, would you recommend hysterectomy after chemoradiation for patients with locally advanced cervical cancer?
We would never offer a routine hysterectomy unless a planned dose of RT can’t be derived for various reasons (very rare). If the patient has persistent disease after chemo RT, then they are considered for hysterectomy or exenteration based on extent of residual disease and surgical feasibility.
How would you approach second isolated vaginal cuff recurrence in a young patient with FIGO IA Grade 2 endometrioid endometrial adenocarcinoma who received EBRT+ interstitial brachy for her initial recurrence?
The dose delivered initially was on the lower side which may be a reason for recurrence. Normally we aim for 75 Gy EQ2 dose. This is our series for reradiation if exenteration is not an option Ling et al., PMID 30600093.
For a patient with cervical cancer s/p chemoRT, would you consider brachytherapy to downstage tumor to allow for hysterectomy rather than pelvic exenteration?
I am not clear as have not encountered this situation. I would complete chemo RT including brachy to definitive dose and reserve surgery as salvage if there is persistent disease 12-16 weeks after treatment.
When do you include the presacral nodes in post-operative XRT of endometrial cancer?
Cervical stromal invasion (pT2) or for definitive radiation for nodal or vaginal recurrence when treating the whole pelvis.The new Gyn postop atlas recommends if in including presacral to treat down to the pyriformis muscle. Historically, RTOG/GOG recommended S1-S3. PORTEC-3 used a 10mm in front of ...
How would you treat a recurrent endometrial cancer at the vaginal cuff that was initially FIGO 1A with no adj treatment, in a patient with actively treated scleroderma?
I would favor brachytherapy alone using MRI based planning with either a multichannel or hybrid applicator. Dose 6 Gy x 6 to CTV and higher dose (hot spots) to GTV.
How would you treat completed resected rectosigmoid recurrence of endometrial adenocarcinoma?
We have equally treated with chemotherapy for recurrence followed by involved site with RT in a few cases for isolated extended pelvic relapse. Overall outcome has been mixed.