Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are there any situations in which you would offer brachytherapy alone instead of whole pelvis RT +/- brachytherapy for an endometrial cancer vaginal cuff recurrence?
Limited series in the past where only brachytherapy alone was done for salvage without EBRT reported high pelvic nodal relapse.One such series is Baek et al., PMID 27614661The only situation where I have done brachy alone is in patients who have had previous EBRT or have other contraindications to E...
Do you take patients off anticoagulation for tandem and ovoid or tandem and ring procedures?
We don't take them off anti coagulant for intracaviatry alone unless using a hybrid applicator
How would the presence of micro-metastatic disease in multiple sentinel pelvic lymph nodes change your recommendation for adjuvant therapy in a patient with otherwise stage I endometrioid adenocarcinoma?
Currently, we treat like stage III disease with chemotherapy followed by adjuvant EBRT for decreasing LRR and control any residual nodal disease (could be 30% based on FIRES) left behind as had only SNLN done. The outcome appears to be better than macrometastases.If only ITC then no chemo for now bu...
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.