What is the longest acceptable interval between hysterectomy and vaginal cuff brachytherapy for high/intermediate risk endometrial cancer in the age of COVID-19?
There is no definitive data for this question but I agree with @Sushil Beriwal. We usually recommend postop VCBT after hysterectomy within 4-6 weeks for wound healing at vaginal cuff. I have seen a patient with small bowel in the upper vagina due to vaginal cuff dehiscence.
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Radiation Oncologist, Medical Director Radiation Oncology, Community Practice (South)
November 11, 2021
GOG trials require patients to start adjuvant treatment within 8 weeks of hysterectomy.
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Sushil Beriwal
Varian Medical Systems/Allegheny health network
I would treat with EBRT to primary plus both inguinal regions followed by image based brachytherapy. Would add concurrent chemo if bulky disease. Dose of EBRT adjusted based on overlapLing et al., PMID 30600093
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Zachary Horne
Allegheny Health Network
I would utilize a combination of EBRT and HDR-BT as well as adjuvant chemotherapy, if medically fit for such. If declining brachytherapy, recent reports on SBRT for GYN cancers as a boost modality can help guide planning to avoid excess toxicity risk.The ESGO/ESTRO guidelines have a section for medically unfit patients and recommendations:Concin et al., PMID 33604759As well as support from some of the recent series:Shen et al., PMID 36711065GYN SBRT series:Ladbury et al., PMID 37875223
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Sushil Beriwal
Varian Medical Systems/Allegheny health network
I would favor EBRT plus brachy boost.Here is a review and our treatment philosophy Musunuru et al., PMID 35248784
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Sushil Beriwal
Varian Medical Systems/Allegheny health network
I would avoid as the risk is more than the benefit and would consider brachy only.
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Sushil Beriwal
Varian Medical Systems/Allegheny health network
I would treat with pelvic adjuvant RT.Musunuru et al., PMID 35248784
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Ashwin Shinde
Vanderbilt-Ingram Cancer Center
No data I am aware of for POLE status portending for better prognosis in non-endometrioid histologies.
For this patient, I would treat as per our institutional (and NCCN-supported) standard, which is chemotherapy + cuff brachytherapy.
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Sushil Beriwal
Varian Medical Systems/Allegheny health network
I prefer, most of the time, between the cycles of chemotherapy (1 to 3) based on logistics.
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Sushil Beriwal
Varian Medical Systems/Allegheny health network
Retrospective data suggest pelvic RT helps but the volume of pelvic RT is variable as much of the data is in the 2D era. I usually treat common, external, and internal iliac in recurrent disease but would be reasonable to exclude common illiac node if morbidity is a concern.Vargo et al., PMID 25241996
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Ashwin Shinde
Vanderbilt-Ingram Cancer Center
Presuming that this is an endometrioid cancer - I would start with RT +/- chemo. There is potential for there to be sufficient shrinkage to facilitate brachytherapy boost. I do appreciate the link Dr. @Price published, and would consider doing SBRT with a neoadjuvant dose how we would as per Dr. @Beriwal's paper (say 5 Gy x 4 rather than 5 Gy x 5) boost prior to planned surgical resection (assuming sufficient downstaging).
A separate comment I'll make about downstaging endometrial cancer - the ...
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Kathryn McGonigle
Legacy Health System
Gynecologic oncology research was strong at ASCO 2023. Results of the following 3 pivotal studies are practice changing.
Marie Plante, MD: SHAPE trial: This non-inferiority CCTG (Canadian Cancer Trials Troup) trial enrolled 700 patients with low-risk squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma of the cervix). Low-risk disease was defined as Stage 1A2, 1B1 (lesions <2 cm) with limited stromal invasion (<10 mm on LEEP or cone and <50% depth on MRI). Conization/LEEP...
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We usually start no later than 9 weeks post hysterectomy. It is based on this retrospective study.