What are your image guidance instructions for post-op endometrial cancer EBRT?

We treat all these patients with IMRT now and they are simulated with full and empty bladder. We do not place any fiducials as they tend not to stay in place.

Patients are always treated with full bladder and empty rectum (as much as possible).

Daily CBCT is used for matching bladder and rectum an...

Match to the bone and ensure vaginal cuff CTV is within PTV each day on offline or online review. If not then replan with a larger margin.

We treat these patients usually on a Halcyon so they receive daily CBCT matched to bone. Full bladder, empty rectum. We do not try to match on the vagina. We do not place fiducials in the vagina - they don’t always stay in either.

As above but will get the patient off the table to get better bladder filling if <~2/3 full on CBCT. If overfilled, I have the therapists call me to verify that the vaginal ITV is still within PTV but won’t have the patient void otherwise.

I sim, even post-op cases, with empty rectum and full bladder, then get them off the table, urinate, and back on for an empty rectum/empty bladder scan.

Movement is generally minimal, FWIW, but every once in a while, you see something that moves up to 1 cm. This ITV lets me really shrink my PTV vol...