Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a patient with a vaginal cuff recurrence from endometrial cancer not amenable to interstitial brachytherapy, how would you boost after 45Gy?
If not amenable to brachy which is unusual in our practice, we would use IMRT boost to 66 to 70 Gy.
Would you offer adjuvant chemotherapy in addition to pelvic RT in a patient with fully resected pelvic recurrence of endometrial carcinoma?
For endometriod histology For nodal relapse, we do offer adjuvant chemotherapy, extrapolating from benefits seen in stage III disease, but not for isolated vaginal relapse.
Would one expect any significant response of pulmonary metastases with usual dosage of weekly cisplatin during definitive chemoRT for cervical cancer?
This is a great question that we have definitely discussed at our tumor board. Any systemic therapy has the potential to create a response to pulmonary metastasis, however dosing, timing, and duration of treatment all play into how much response is expected. In this setting, I would definitely want ...
How do you decide whether to treat proximal vs. entire vaginal cuff with intracavitary brachytherapy in early-stage endometrial adenocarcinoma?
At M.D. Anderson - we never treat the entire vagina for early stage endometrial carcinoma. In fact, we only treat the proximal 2.5 to 3.0 cm of the vagina in most case but may increase with by 1.0 cm for patients with papillary serous or carcinosarcoma histology with brachytherapy. We have excellent...
In a pre-menopausal female with cervical cancer, would you boost a hypermetabolic ovary on PET?
Hypermetabolic ovary is very common and physiologic in premenopausal women and I would not boost that area. MRI pelvis can confirm benign nature of this uptake
What clinical factors would lead to utilizing a tandem and cylinder rather than tandem and ovoid for cervical cancer brachytherapy?
Tandem and cylinder should be used with caution as it is hard to cover the entire cervix and paracervical region with tandem and cylinder. If the patient has lower vaginal disease with good response to chemo RT, one can use tandem and cylinder but may need some needles to cover entire cervix.
What is your institutional protocol for an incidental finding of an adnexal cyst on CT simulation for cervical cancer?
It is not common to have this finding. A combination of PET CT and MRI confirms the benign etiology of these cysts and can be ignored for cervical cancer management.
Would the presence of multifocal LVSI change your adjuvant treatment recommendation for a surgically staged IA dedifferentiated endometrial carcinoma?
Dedifferentiated is considered a high-grade lesion. There is admittedly low quality evidence on optimal management given lower incidence.I would recommend treatment with vaginal brachytherapy and very much offer chemotherapy. Would prefer vaginal brachytherapy, given the patient was surgically stage...
Would you offer consolidative radiation for oligometastatic uterine serous CA s/p surgery and chemotherapy with complete response?
Usually not unless pelvis only confined disease at presentation or microscopic omental disease removed at surgery.
What are indications to add WPRT +/- PA field to chemotherapy for uterine serous carcinoma?
There is variation in practice. After adequate surgical staging, our approach: Stage 1A brachytherapy alone. Stage IB and above, EBRT. If node negative, treat pelvic including entire common iliac. If pelvis node positive and PA node dissected same as above, up to common iliac. If pelvis is posit...