How do you modify the management of an SLE patient with active systemic lupus for a gynecological cancer that normally requires pelvic radiation and brachytherapy?

I have not done any specific modification for SLE. I would treat with VMAT and IGRT with a 5 mm PTV margin and ensure EBRT and HDR meet ideal dose constraints for OARs.

For the EBRT component, I would consider proton therapy, which would spare the majority of normal tissues from the low and intermediate-dose bath.