Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your technique to calculate the vaginal surface dose in gyn intracavitary brachytherapy?
The limited published data on image based brachytherapy has not found any dosimetric correlate of upper vaginal morbidity. The traditional point dose tolerence has underassessed tolerence of the upper vaginaThe recent multi-institutional EMBRACE study with different techniques and dose of cervical b...
What is your approach to a cervical SCC patient in which you're unable to properly place a T&O, due to obliterated cervical os, after completion of EBRT?
In our experience this is an extremely rare circumstance if the implant is done with ultrasound guidance--certainly <1% of cases. Depending on your level of experience and confidence, it may be worth referring the patient to a more experienced brachytherapist. That said, there are rare cases, partic...
How do you match a para-aortic field to a previously irradiated whole pelvis field in a woman with PA nodal failure after definitive chemoRT for cervical cancer?
We try to treat entire PA region and match to pelvic field (match two 50 percent isodose line) with .5 to 1 cm of safety factor based on nodal location
How do you treat endometrial cancer in the setting of a pCR after neoadjuvant chemotherapy?
There is no data to guide. I would favor pelvic RT based on initial stage IIIB disease. We, at our institution, usually treat these patients with neoadjuvant chemo RT followed by surgery.https://www.ncbi.nlm.nih.gov/pubmed/25218303
Are you using the new FIGO 2018 staging or waiting until it is incorporated into the next AJCC edition?
It will take 6-8 months for the incorporation into AJCC. Since our tumor registry follows AJCC, we are waiting for it to be done for uniformity of reporting.
What alternative boost methods (techniques / dose) do you recommend for a vaginal cuff boost after whole pelvis when imaging shows bowel adherent to the vaginal cuff?
I usually prescribe to surface in these scenario rather than thickness. 6Gy x2
Would you recommend radiotherapy for a para-aortic recurrence of endometrial cancer in a patient who previous completed surgery, chemotherapy, and WPRT?
Yes, as a set of these patients are cured. I would treat pa chain with SIB to node along with concurrent cisplatinum to definitive dose
How do you plan for excess nonconforming vaginal tissue with a HDR cylinder?
CT based plan. You do end up seeing paravaginal tissue not covered by single channel cylinder. We have not chased that in adjuvant setting with outcome data showing low recurrence rate. Similar thoughts about small air gaps Richman et al., PMID 33384254.
What is the best method for ensuring that vaginal cuff cylinder is in proper position at each fraction?
The best method depends on local context and what tech is available. For imaging, one can: re-CT each treatment, use fluoro (we have a C-arm), use the kV or MV imager on a Linac with an orthogonal pair or a CBCT. There are other methods also. Some practices don’t image verify (makes me nervous). For...
What is your adjuvant therapy for node positive, low grade endometrioid endometrial adenocarcinoma?
Chemotherapy (typically carboplatin/paclitaxel x 6 cycles), restage, and if no progression, whole-pelvic RT. Consider brachytherapy boost if cervical stromal or vaginal involvement and/or presence of other risk factors for vaginal cuff recurrence (e.g. LVSI, deep myometrial invasion, grade 3 [not in...