Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your strategy to deliver EBRT, brachytherapy, and a parametria/lymph node boost in less than 7-8 weeks for cervical cancer?
These are the things we do to accomplish this: 1) Up-front planning for the entire course. Schedule brachys before the start of external beam, particularly if you are dependent on an OR, gyn oncologist or anyone else who might require advance notice. The first brachy should be scheduled no later tha...
What are you posterior field borders for endometrial and cervical cancer 3DCRT plans?
The idea behind placing the posterior border 5 mm behind the sacrum on the lateral fields is to include the presacral fossa where the presacral nodes reside. I recommend covering the presacral nodes for all definitive cervix patients, both for prescral node coverage as well as to cover the parametri...
How do you decide on adjuvant therapy in a patient with a Stage IA uterine carcinosarcoma without any myometrial invasion?
There is no good prospective study. Our approach, based on outcome and retrospective data (including NCDB), is brachy plus chemo. https://www.ncbi.nlm.nih.gov/pubmed/30170976This is paper I was referring to. With all the caveats of NCDB studies, it givess some objective information where prospective...
Do you recommend concurrent chemotherapy with XRT for inoperable patients with stage I-II high-risk endometrial carcinoma?
For inoperable patients due to medical comorbidities, we have been reluctant to add chemotherapy because of the concern about side effects. For inoperable patients due to disease extent, we routinely add concurrent chemotherapy.https://www.ncbi.nlm.nih.gov/pubmed/25218303/
How would you deliver pelvic radiation as cost-efficiently as possible for a patient with endometrial cancer?
I think that a 4 field plan to 45 Gy in 25 fractions without cuff brachytherapy would reduce cost without deviating from the standard of care. We would expect that to come with modestly more acute and chronic toxicity than IMRT. I think we need more evidence before a 5 fraction regimen could be reco...
When would you consider sequential chemotherapy and radiation rather than concurrent for early stage cervical cancer with high risk pathologic features?
How much of the results of the STARS (Huang et al., PMID 33443541) (showing improved DFS with SCRT compared to CCRT) driven by only a 62% completion rate of CCRT (compared to 73.4% in SCRT, p< 0.001) as per the specified protocol is unknown.While the authors state within their results section that t...
Is obesity a risk factor for recurrence after definitive treatment for endometrial cancer?
The most common cause of death in early stage endometrial cancer is not cancer but cardiovascular. Anything to reduce cardiovascular risk would help reduce mortality
Do you add chemotherapy to salvage EBRT/brachytherapy for a pt with small vaginal cuff recurrence of cervical CA s/p hysterectomy?
Yes, we do treat with concurrent chemo radiation (not much data).
How would you treat a patient with pT1bN0 G1 endometrioid carcinoma with significant MMI (~80%) and +LVSI?
Brachy alone, unless substantial LVSI then would favor EBRT.
When, if ever, would you offer adjuvant radiation to a patient with stage IVB endometrial cancer following neoadjuvant chemotherapy and cytoreductive surgery?
Stage IVB can have a large spectrum based on the extent and volume of metastatic disease. The NCDB dataset has lots of selection bias in who gets EBRT and also no data on DFS or recurrence pattern. I have usually avoided adjuvant RT unless pelvis is only confined to stage IVB disease.