Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is it ever acceptable to treat low pelvis (vs. whole pelvis) for an early vaginal recurrence of endometrial cancer?
Retrospective data suggest pelvic RT helps but the volume of pelvic RT is variable as much of the data is in the 2D era. I usually treat common, external, and internal iliac in recurrent disease but would be reasonable to exclude common illiac node if morbidity is a concern.Vargo et al., PMID 252419...
How do you manage a patient with cervical cancer who has FDG uptake in bilateral ischial tuberosities with lytic areas on CT correlate, and also has a history suspicious for untreated polymyalgia rheumatica with chronic symptoms in the same anatomic locations?
I would be very interested in the opinion of a rheumatologist regarding the etiology of the lytic disease in the ischial tuberosities. A decision should be made on whether to biopsy one of these lesions. My suspicion is that it is unrelated to cervical cancer, but that possibility needs to be consid...
For a medically inoperable clinically-staged FIGO IA endometrial cancer with serous, clear cell or other non-endometrioid, high-risk histology treated with EBRT alone, would you cover elective lymph nodes, or treat the uterus alone?
I would utilize a combination of EBRT and HDR-BT as well as adjuvant chemotherapy, if medically fit for such. If declining brachytherapy, recent reports on SBRT for GYN cancers as a boost modality can help guide planning to avoid excess toxicity risk.The ESGO/ESTRO guidelines have a section for medi...
How would you treat recurrent endometrial carcinoma with a presentation of inguinal and external iliac adenopathy?
I would treat with definitive intent with either surgery followed by (chemo) RT or definitive (chemo) RT targeting the pelvic at least up to the common iliac and bilateral inguinal region.
Would uterine perforation at the time of hysterectomy push you to recommend pelvic RT in a patient who would otherwise receive cuff brachytherapy?
It very likely would. I suppose that various factors could impact the decision, including the usual prognostic factors, patient's general condition and co-morbidities, etc. But, yes, a uterine perforation at the time of hysterectomy would represent another risk factor that would push me to be more a...
Would focal clear cell features change your management for a grade 2 endometrial adenocarcinoma?
We do know clear cell predicts for worse outcome but don’t know volume required for it to be independent factor. In clinical trial they require at least 10 percent of volume to be clear cell not based on outcome but more on consensus. In our practice, if they have focal clear cell I would at least o...
In what situations would you perform a sentinel lymph node biopsy for cervical cancer?
At my institution we currently consider doing sentinel lymph node dissections for all patients with FIGO stage IA2-IB2 (2018 staging system) who have normal appearing nodes on CT scan. Our protocol utilizes indocyanine green (ICG) tracer and the near infrared detection with ultrastaging. If one side...
What is your strategy for treatment of FIGO IIB cervical cancer in a patient who poorly tolerated the first insertion and refuses subsequent insertions?
Psychological distress is common in cervical cancer patients treated with brachy; it's a painful and scary procedure. At another facility, hospital-based, I've used the OR for all of my tandem and ovoid insertions, with really optimal packing that gave good dose distributions and good patient comfor...
What is the longest interval to proceed with brachytherapy boost for cervical CA after EBRT?
I would proceed with brachytherapy even after a delay of 2-3 months as that is still better than no brachy and if local recurrence occurs, then the patient would need exenteration. Another option to consider, if imaging and scan show great response to EBRT, it is the possibility of a hysterectomy. I...
Is adjuvant treatment recommend for a 0.8cm serous endometrial CA confined to polyp s/p hysterectomy + surgical staging?
For surgically staged IA confined to polyp, the risk of recurrence reported in literature varies but on average, appears to be low and recent ESGO guidelines favor no treatment.