Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach treatment for a primary carcinosarcoma of the cervix with pelvic and para-aortic nodal involvement?
There is limited information on this situation. A series from Washington University (Gynecol Oncol 2005; 99: 348) demonstrates that curative intent treatment can be rewarded with long term survivals if disease is confined to the pelvis. Curative treatment could include chemo-RT, radical surgery, or ...
How would you approach a young patient with a locally advanced endometrial cancer with cervical involvement and a solitary bone metastasis?
I would need to know what is meant by locally advanced endometrial cancer. Locally advanced cervical cancer usually means not operable (except IB2) so is this a T3N?M1 pt with a bone met? That is IVb. I agree with bone biopsy but endo does go to bone so I would not be surprised if this was positive....
Would you offer adjuvant RT to a FIGO IV endometrial CA with pulm mets s/p hysterectomy with residual disease, then cCR to both sites after chemotherapy?
For stage IVB with extra pelvic mets to lung or liver, I have not offered adjuvant RT as the high risk of other mets would negate any benefit of adjuvant RT. If they develop isolated local relapse, then would consider for salvage.
How do you address extended break from EBRT during cervical cancer treatment?
EMBRACE data suggest HRCTV dose needs to be increased by 5 Gy for each week delay beyond 50 days to counter the downside of delay. We try to do that using hybrid applicator but total dose is still limited by OAR dose and we try to push as much as we can. (HRCTV to 90-95 Gy)
What would you recommend in the adjuvant settings for an elderly patient status post hysterectomy without nodal staging and was found with FIGO 1A, G3 endometrial cancer, with no LVSI and no myometrial involvement, without nodal staging?
Imaging for staging. Brachytherapy alone as adjuvant treatment.
What is the optimal management of a pelvic sidewall recurrence of endometrial cancer in a patient who has not previously received radiation?
A significant percentage of women with a pelvic sidewall recurrence can be salvaged with definitive chemoradiation. We would typically use IMRT, treating a CTV encompassing the pelvic nodes to 45-50 Gy and using an initial integrated boost to treat the gross disease to 50-55. A sequential boost to b...
Do you recommend adjuvant pelvic RT for Stage 1 cervical adenocarcinoma?
At M.D. Anderson we do treat histology as a independent high risk factor - but only moderately to poorly differentiated adenocarcinomas. Grade 1 adenocarcinomas are considered low risk and that histology is not considered as an independent risk factor. So if the case is borderline and the patient ha...
When do you offer observation for resected stage II endometrial cancer?
Fortunately, this is an uncommon situation. Even with stage II disease, there is no clear advantage to radical hysterectomy, and it subjects the patient to higher surgical morbidity, especially genitourinary. To my knowledge, data is sparse in terms of when it is appropriate to withhold any adjuvant...
How do you plan urgent radiation therapy for vaginal bleeding caused by locally advanced cervical cancer?
Agree with @Dr. First Last, we do the same and start at 1.8. Vaginal packing (you can treat with the packing in), transfuse if needed given bleeding. 4-field to start and can turn around a box within a couple hours, and then switch to IMRT as soon as approved. We also try to start the chemo quickly....
For stage IB1 cervical cancer s/p surgery with only 1 Sedlis criteria, should adjuvant pelvic EBRT or vaginal cuff brachytherapy be recommended in the presence of other adverse pathologic features, such as high tumor grade or very close but negative margins?
For patients with close margin would offer EBRT plus brachyhttps://www.ncbi.nlm.nih.gov/pubmed/16750323