Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you change your approach to adjuvant radiation for an incompletely staged, at least IB, grade 1 endometrial cancer, if a uterine perforation occurred at time of surgery?
Similarly to the above authors, I agree with offering this patient vaginal brachytherapy. Though she does not definitively meet GOG99 criteria, given the situation with deep myometrial invasion and perforation, this is a reasonable and low-risk treatment opportunity to decrease local recurrence. The...
In patients diagnosed with endometrial cancer who do not undergo SLNB or LND at the time of hysterectomy, what criteria is used to recommend completion surgery for LN assessment?
The value of nodal dissection was negative for survival in two trials and PORTEC 1 and 2 (no nodal staging), and GOG 99 (nodal staging) didn’t show any difference in nodal recurrence for most endometroid stage I cancer. Unless management would change, we usually limit redo surgical staging to advers...
Would you offer pelvic radiation in a patient with Stage IIIC endometrial cancer who has Crohn's disease and a permanent ileostomy?
I would avoid as the risk is more than the benefit and would consider brachy only.
In a patient with previous cervix cancer treated with surgery and adjuvant EBRT who presents with recurrent HGSIL, status post vaginectomy, would you consider brachytherapy?
I would consider advanced imaging such as MRI with vaginal gel to rule out the presence of a supravaginal lesion. Otherwise, I would not treat following excision of the HSIL lesion, even if margins were positive for dysplasia. HPV testing can be done to risk stratify. However, excision/ablation is t...
Do you add pelvic RT for stage II gr 2 endometrial cancers with multiple high risk features?
I would treat with pelvic adjuvant RT.Musunuru et al., PMID 35248784
For which patients with stage IA nonsurgically staged endometriod cancer would you add pelvic RT?
At present, for most of these patients we would not add EBRT irrespective of nodal staging.The only subset where would consider EBRT is stage IA, grade 3 with LVSI, as they were underrepresented in PORTEC 2. In the ongoing PORTEC 3, they are treated like high risk with randomization between EBRT or ...
What pelvic fields do you treat for patients with FIGO IA2-IB cervical cancer patients who inadvertently get a simple hysterectomy but with lymph node sampling (for presumed endometrial carcinoma)?
This situation used to be referred to as a "cut-through" hysterectomy (even though the surgeon did not cut through tumor). The devil is in the details for something like this. How thorough was the dissection? How deep the invasion? However, some generalizations can be made. The upper 1/2 of the vagi...
Are there instances where you prefer an SBRT boost rather than a brachytherapy boost when treating definitive locally advanced cervical cancer?
No.
In what scenario would you give consolidation chemotherapy after chemoradiation for stage 3 cervical cancer with a good response?
The current standard for stage IIIB cervical cancer is primary external beam radiation + concurrent cisplatin based chemotherapy + brachytherapy (see NCCN guidelines CERV6). Clearly, given the failure rate with distant metastases after primary therapy, there exists significant interest in adjuvant c...
For a patient with recurrent endometrial cancer involving the vagina with a good response to EBRT (<5mm residual), how would you prescribe adjuvant brachytherapy with a cylinder to the entire vaginal length?
We focus on pre EBRT length, as recurrence patterns don’t support needing to treat the full length with 45Gy from EBrT sufficient, and series that have treated full length have shown higher toxicity.See discussion of this for summary of literature for volume of treatment.