Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For which patients with stage IA nonsurgically staged endometriod cancer would you add pelvic RT?
At present, for most of these patients we would not add EBRT irrespective of nodal staging.The only subset where would consider EBRT is stage IA, grade 3 with LVSI, as they were underrepresented in PORTEC 2. In the ongoing PORTEC 3, they are treated like high risk with randomization between EBRT or ...
What pelvic fields do you treat for patients with FIGO IA2-IB cervical cancer patients who inadvertently get a simple hysterectomy but with lymph node sampling (for presumed endometrial carcinoma)?
This situation used to be referred to as a "cut-through" hysterectomy (even though the surgeon did not cut through tumor). The devil is in the details for something like this. How thorough was the dissection? How deep the invasion? However, some generalizations can be made. The upper 1/2 of the vagi...
Are there instances where you prefer an SBRT boost rather than a brachytherapy boost when treating definitive locally advanced cervical cancer?
No.
In what scenario would you give consolidation chemotherapy after chemoradiation for stage 3 cervical cancer with a good response?
The current standard for stage IIIB cervical cancer is primary external beam radiation + concurrent cisplatin based chemotherapy + brachytherapy (see NCCN guidelines CERV6). Clearly, given the failure rate with distant metastases after primary therapy, there exists significant interest in adjuvant c...
For a patient with recurrent endometrial cancer involving the vagina with a good response to EBRT (<5mm residual), how would you prescribe adjuvant brachytherapy with a cylinder to the entire vaginal length?
We focus on pre EBRT length, as recurrence patterns don’t support needing to treat the full length with 45Gy from EBrT sufficient, and series that have treated full length have shown higher toxicity.See discussion of this for summary of literature for volume of treatment.
Would you offer definitive RT to a patient with metastatic cervical adenocarcinoma s/p carbo/taxol/avastin with a partial response in the metastatic sites?
I have delivered definitive pelvic chemoradiotherapy to a handful of patients who had complete radiographic responses to neoadjuvant TCA. All patients remain disease-free several years later. As for a patient with only a partial response, I believe there is still a good argument to be made for the a...
How would your follow-up change for a patient, non-surgical candidate, with endometrial cancer treated with definitive radiation?
I assume that the question refers to how follow-up would differ between a patient treated adjuvantly, i.e., following surgery, versus treated definitively, i.e., not a surgical candidate. I think there are quite a few variables here. Probably the most important consideration is the extent to which t...
Would you offer any adjuvant therapy for cervical cancer following total pelvic exenteration in the setting of a positive pelvic lymph node?
I am going to "eat a bit of crow" here and admit to having been schooled a bit by the esteemed Dr. @Dr. First Last. I admit to having immediately jumped to the post-rad hyst situation rather than post-exenteration, and I agree that the radicality of the operation could factor into the decision about...
Would you modify standard WPRT+brachy radiation for cervical SCC s/p negative nodal staging but aborted hysterectomy due to previously undetected superficial vaginal disease?
Would treat same with EBRT to 45 Gy in 25 fractions. (Pelvis) With concurrent chemo and brachy.
When do you consider re-irradiating patients with recurrent cervical cancer?
Because I have been seeing and treating a reasonable number of these cases for 35 years, I have some strong opinions on the matter. Although external beam re-irradiation in the setting of recurrent cervical cancer is fraught with great hazards and poor outcomes, interstitial re-irradiation has a hig...