How do you treat a locally advanced cervix cancer in a patient who declines brachytherapy?

You provide this lady with a curable disease the appropriate social support, mental health support, and transportation coordination in order for her to complete curative treatment with brachytherapy. Anything short of that in America with all our incredible resources and care options is substandard care and will cost her her life.

Tumors win when the system fails. Brachytherapy is the only way to go.

Sorry but respectfully to the group, knowing full well the many challenges in our medical system...

It depends on the circumstances.

It’s not uncommon that brachytherapy patients decline initially due to the logistics of treatment. Some patients travel many hours for their brachytherapy and have limited resources and/or support. We involve social work and nurse navigation to get them transportation and hotel nights near our center set up very far in advance.

If brachytherapy is truly not feasible, even with some timeline delays, I would tread cautiously, employing aggressive bowel preparation, f...

After years of work in a developing country where patients often had access to external beam radiation but not brachytherapy, I have made the following observations:

In locally advanced cervical cancers, the bladder and/or ureter are often densely adherent to the cervix and this is very often not improved by radiation therapy, despite a good clinical response. So if completion hysterectomy is chosen in this circumstance, the surgeon must be prepared to accurately evaluate the position of the uri...

I’ve had a few patients who could not go through brachytherapy for some reason, such as a pulmonary embolus or inability to turn up. I tried to mimic the dosimetry of an implant and crossed my fingers. It’s difficult as the position of the target structures can change. You need adaptive therapy. I’ve had good luck in a few.

All efforts should be made to provide access to brachytherapy and address patient-specific concerns (i.e. sedation for implant and removal), fractionation, travel, etc.

Patients with medical contraindications who cannot receive any anesthesia or bleeding risk whatsoever, have done daily adaptive MR linac treatment and can achieve similar D90 to CTV as in brachy, although with obvious dosimetric differences to brachy. I would definitely recommend Foley catheter placement as bladder filling is cri...

Brachytherapy is vital to the treatment of cervical cancer. Practices when possible, should avoid treating the cervix without brachytherapy experience and availability.

Unfortunately, anyone who has a large cervical brachytherapy practice has encountered patients that for medical, logistical, or psychological reasons cannot undergo brachytherapy. With the right educational and team approach, two of these three, the logistical and psychological barriers, may be overcome. Charitable organizations c...

There’s a difference between unable to undergo brachytherapy and declines. Electing to decline brachytherapy is below the standard of care and the patient needs to find another doctor.

Completion hysterectomy.