How would you manage a recurrent cervical cancer previously treated with vaginal cuff brachytherapy and has had a complete response to chemo-immunotherapy?

Ling et al., PMID 30600093 -

The paper gives our philosophy in this scenario. The total dose is the function of dose to target and cumulative dose to rectum and bladder. To be able to give a higher dose with brachy, generally would favor around 30.6 Gy with EBRT and then limit the last 14.4 Gy to the...

We have no data suggesting a long-term cure with immunotherapy.

In this unfortunate situation, I would be comfortable going well beyond traditional tolerances. The patient has already locally failed one course of brachytherapy and a lesser dose would unlikely be curative. I would deliver 45 to 50 gr...

I agree with the answers above.

I would aim for an EQD2 of 65-70 Gy for this course for the primary tumor. However, would favor 45 Gy to the pelvic nodes.

I would recommend interstitial brachytherapy, especially if the recurrence is 3-4 cm. I often prescribe 6-6.5 Gy x3 fractions with brachytherapy.

To clarify the initial therapy/clinical scenario - a post-op cervical (not uterine) cancer had surgery and then VBT alone, no EBRT? I'm not entirely sure of the rationale behind that thought process as that would not be a routine clinical workflow. Obs or EBRT (or chemoRT) are the mainstays here aft...