How would you approach second isolated vaginal cuff recurrence in a young patient with FIGO IA Grade 2 endometrioid endometrial adenocarcinoma who received EBRT+ interstitial brachy for her initial recurrence?

The dose delivered initially was on the lower side which may be a reason for recurrence.

Normally we aim for 75 Gy EQ2 dose.

This is our series for reradiation if exenteration is not an option Ling et al., PMID 30600093.

It is always disappointing when patients recur, especially when they are at a young age. In this case, I would ideally have a PETCT scan to ensure there are no other sites of disease given that this is a second recurrence in a radiated field. If PETCT shows nothing else, then I would assess her for surgical resection with the goal of achieving negative margins.

A surgical resection in this situation will require careful preoperative counseling. I would be sure to counsel her carefully on the add...

Interstitial re-irradiation is an excellent option for this patient, and salvage (cure) is possible. I use permanent seeds (now Cs-131), which provide continuous low dose-rate radiation. This is safe, with very low complication rates, and often quite effective. Ultimate salvage rates are mostly influenced by the size of the recurrence, the disease-free interval, and giving an adequate dose. We have published several papers on this. Here are 2: Wooten et al., PMID 24556059, and Feddock et al., PM...