Would you offer palliative RT for a patient with a pelvic mass fistulizing to large bowel?

The patient has metastatic ovarian cancer, currently on Avastin, with a large 13 cm pelvic mass with a fistula to large bowel.

Would you consider offering pelvic RT if you waited a for 3-4 week Avastin washout period, and the patient had exhausted other pain management options?

Or alternatively, do you feel this is a case where radiation is contraindicated and the patient should focus on medical management?

Answer from: Radiation Oncologist at Academic Institution

I would generally not be comfortable giving palliative irradiation unless the bowel had been diverted, particularly in a patient receiving Avastin. The risk of perforation and sepsis would likely be high. However, if the fecal stream is diverted above the fecal stream and the patient has no evidence...

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Radiation Oncologist at Up Health System Marquette
Treating the pelvic mass would put the bowel at ri...

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