Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage a distal vaginal recurrence of endometrial adenocarcinoma in a patient who had adjuvant external beam and cylinder brachytherapy boost to the top 4 cm of the vaginal cuff?
I would treat with EBRT to primary plus both inguinal regions followed by image based brachytherapy. Would add concurrent chemo if bulky disease. Dose of EBRT adjusted based on overlapLing et al., PMID 30600093
How would you manage a patient in her 50s with FIGO IA clear cell carcinoma of the endometrium with extensive LVSI and ITCs in an obturator node after 6 cycles of carbo/taxol?
I would favor EBRT plus brachy boost.Here is a review and our treatment philosophy Musunuru et al., PMID 35248784
How would you treat an endometrial cancer with pelvic sidewall nodes, patient s/p TAH/BSO but nodes were fixed and unresectable?
We would treat with IMRT and IGRT with concurrent cisplatinum based chemotherapy, with SIB boost dose to involved nodes (dose based on size and proximity of critical organs) followed by adjuvant chemo.
What is the maximum time you would wait after hysterectomy to start RT for a FIGO II endometriod adenocarcinoma before cancelling treatment and saving for salvage?
Great question, and I don't know that there is a perfect answer. If I were going to answer with some specificity, I would say 4 months. Obviously this is not ideal. However, in the presence of more compelling indications for treatment (your question relates to stage II patients/stromal invasion), I ...
With COVID-19 worries, are you more likely to offer women with endometrial cancer vaginal cuff brachytherapy over EBRT?
I would treat with brachy alone, as even in a non COVID environment with her comorbidities, the benefit of EBRT is minimal in terms of survival.
Do you sample radiologically negative paraaortic nodes in cervical cancer patients with clinically positive pelvic nodes prior to initiating primary chemoradiation?
Possible options in PET-positive pelvic nodes and negative PA nodes: Treat at least the entire common iliac chain, including the aortic bifurcation nodal region, which is 1 level above the affected pelvic nodes. Treat the subrenal PA region prophylactically, especially if the common iliac region or ...
How would you treat cervical stump SCC involving bladder, pelvic nodes, and port-site metastasis in a patient post-laparoscopic hysterectomy?
No standard approach. If good KPS, would favor treating with definitive chemo RT with EBRT plus interstitial plus weekly cisplatinum. For port site recurrence depending on volume, would favor local excision vs. definitive RT dose.
Would you offer brachytherapy for a patient with metastatic cervical cancer s/p 30Gy/10 fx to the pelvis followed by chemotherapy who only has isolated disease in the cervix?
Control of central pelvic disease in cervical cancer is a main goal of treatment, regardless of whether the patient has metastatic disease or not. This is important for maintaining quality of life. Death from central pelvic disease is very unpleasant. Therefore, I recommend brachytherapy in this pop...
Do you modify your treatment for a patient with ulcerative colitis needing vaginal brachytherapy?
For adjuvant treatment, I switch to 6 Gy x 5 to surface to reduce total dose to rectum instead of 7 Gy x 3 at 5 mm. Also, sometimes I have used a multichannel cylinder to off load Isodose line from rectum based on anatomy. By doing as above d2cc of rectum is usually in the 10 Gy range which is way l...
Do PORTEC-3 and GOG-258 change your approach to managing patients with high-risk or node positive endometrial cancer?
The ambiguous answer is "yes and no." The positive impact of RT on vaginal and nodal failure rates cannot be ignored and argues for a continued role for RT, probably external RT. There are a number of caveats relative to the interpretations of GOG 258. These include (but may not be limited to) high...