Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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.
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.
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...
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...
How do you best manage bulky, clinical stage IIA squamous cell cancer of the cervical stump in a patient with a previous partial supra-cervical hysterectomy?
This is not a common scenario in the clinic. It is an older type of surgery to do supracervical Hysterectomy. For stage IIA Sq. cell ca of Cx in the stump, I would start with chemoRT to pelvis to 45-50GY and then depending on the length of the stump if at least 2.5-3cm would offer intracavitary bra...
What factors do you use to determine whether to add brachytherapy to EBRT for IIIC endometrial cancer?
My philosophy is to use 45 Gy in 25 fractions of EBRT followed by two fractions HDR boost.
Would the findings of a synchronous T1a ovarian endometrioid adenocarcinoma affect your treatment recommendation for a IB, G2 uterine endometrioid adenocarcinoma and LVSI?
These cases are always difficult to know if it is synchronous primary or metastatic disease and sometimes pathologist are able to clarify and other times not. Outcome is significantly better if they are synchronous primary as it appears to be the case here. If ovarian surgical staging is done, I wou...
How would you approach radiation in a patient with IIIC2 SCC of the cervix with a history of ileoanal reanastomosis and j pouch?
Depends a bit on the specifics of the case (e.g. how big is the cervix?), but in general, I would limit the pelvic dose to around 40 Gy and push the brachytherapy dose a bit higher. For the brachytherapy, the use of image guidance potentially provides an opportunity for further limiting the dose to ...
What is your approach to the adjuvant treatment for stage IA grade 2 endometrioid adenocarcinoma without LVSI whose molecular classification is p53 abnormal (MMR intact, POLE wild type)?
These attached guidelines recommend consideration of chemo if IA with myometrial invasion. From a radiation perspective, I do brachy alone with consideration of chemotherapy. Concin et al., PMID 33397713
How would you treat a patient with synchronous locally advanced cervical and ovarian cancers?
At a minimum, I would favor removing the ovarian mass and peritoneal and omental bx to get an idea about ovarian cancer (stage 1 or stage III). Based on that, you may start with chemo first (like carbo and taxol) for the ovarian cancer, and assess local response of cervical cancer then definitive ch...