In light of findings from GOG 258, is the benefit of adjuvant RT in IIIC endometrial cancer worth the potential acute and late risks of RT in the setting of significant autoimmune disease?
Patient with active rheumatoid arthritis, on escalating dose of Rituxan and Methotrexate, also has antisynthetase syndrome and Hashimoto's thyroiditis.
Answer from: Radiation Oncologist at Academic Institution
As in almost any case of endometrial cancer, the decision of what adjuvant therapy, if any, should be recommended is multi-factorial. The goal is to optimize the therapeutic ratio, which includes consideration of the chance of cure and/or local control as well as the risk of acute and late toxicitie...
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Answer from: Radiation Oncologist at Academic Institution
The patient requires chemotherapy at a minimum, which frequently helps to reduce immunosuppressant needs in autoimmune conditions.
If the patient was able to undergo RT afterwards without being on high dose (for RA) methotrexate, I would have a discussion of the pros/cons of pelvic RT in this scena...