Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a cervical cancer patient who develops new oligomet to the spine during primary cis/RT?
The finding of metastatic disease to the spine during primary radiation therapy for cervical cancer suggests the presence of systemic, hematogenous disease at the start of treatment. PET-CT scan and/or bone scan are useful diagnostic tools to detect distant metastases and also to differentiate betwe...
How do you manage a patient with an endocervical cancer indeterminate for endometrial or cervical origin status post TAH/BSO and sentinel node biopsy?
P16 and CEA positivity (although focal) favor cervical cancer. Can also do high risk HPV and p53 as suggested. Either way, the patient looks like they had a simple hysterectomy done and would favor EBRT plus brachy (would consider adding weekly cisplatinum if the overall picture is cervical).
For patients with endometrial cancer, should tumor size be included as a risk factor for recurrence?
Tumor size is not currently used in staging for endometrial cancer.There have been some retrospective studies that suggest a higher rate of local recurrence and recurrence-free survival in patients with endometrial cancer and a larger tumor size (>2-2.5 cm). (Sozzi et al., PMID 29489475) (Han et al....
Do you add chemotherapy to pelvic radiation and brachytherapy for an isolated vaginal cuff recurrence of endometrial cancer?
We offer concurrent cisplatinum with EBRT to high grade or bulky vaginal diseasehttps://www.ncbi.nlm.nih.gov/pubmed/25241996
What treatment would you offer a patient with metastatic cervical cancer to the supraclavicular nodes with a complete clinical response in her nodes, but a 3 cm residual in the cervix?
Patients with stage IV disease because of s/c node only, we treat with definitive intent covering all pre chemo disease with combination of EBRT and brachy, based on limited series for WSU and Korea showing a subset has long disease free interval with potential for cure.
How would you manage recurrent endometrial cancer limited to pelvic and inguinal nodes in a patient with no previous radiation?
If it is a delayed recurrence, we usually treat nodal regions only (going one level above involvement) with IMRT and concurrent weekly cisplatinum chemotherapy with SIB boost to node followed by possible adjuvant chemo.
When do you include the mesorectum for definitive cervical cancer patients getting concurrent chemoradiation followed by brachy?
I would also include it if there is direction invasion into the mesorectum or EMVI.
How would you approach treatment for centrally recurrent cervical SCC with positive margins after excision that was not exenteration?
We treat with concurrent chemo RT with EBRT plus brachy. Total dose of brachy is based on the extent to residual disease. For positive margin as above with non oncological resection, 65-70 Gy equivalent dose. Would get MRI of pelvis with vaginal gel to assess any residual disease.
How would you treat an isolated para-aortic node recurrence 1.5 years after receiving primary chemoradiation for locally advanced cervical cancer?
We treat with definitive chemo RT to pa region using IMRT (weekly cisplatinum with 45 in 25 to pa region and 55-57.5 Gy in 25# SIB to node). Small bowel and duodenum dose constraints (V55 < 5 cc and V55 < 1cc respectively).
What would be your treatment approach for a patient with a new PET positive para-aortic node 3 months following completion of definitive chemoradiation for locally advanced cervical cancer?
My approach would be to treat the entire para-aortic field (above the previous field, obviously) to approximately 45 Gy with conventional fractionation, followed by a boost to the PET positive node to get to a dose of 60 Gy or so, if possible, while respecting the relevant tolerances. If the volume ...