How would you plan your treatment for a locally advanced uterine cancer where there was intraoperative evidence of multiple rectal nodules that are biopsy positive?

This looks like pelvic peritoneal disease along with ovarian spread. If optimal debulking is done, I will reimage after chemotherapy. If imaging is NED, I would consider pelvic RT for clear-cell histology, but the absolute benefit is not known in this scenario, and no RT is also reasonable. I would ...

There are a lot of additional data points that could be helpful:

• Was there pre-op imaging suggestive of any additional disease elsewhere?
• Were the nodules biopsied or resected?
• Were there any other suspicious peritoneal findings intraoperatively?
• Were washings positive?

Given adnexal and rectal se...

After completion of systemic therapy while the patient is getting immunotherapy I would perform staging imaging and if negative I would treat the entire pelvis and the mesorectum including the distal rectum to the full adjuvant dose of 50 Gy in 25 fractions. The patient would continue immunotherapy ...