Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What volumes would you use for salvage radiation in a patient with a pelvic lymph node recurrence of cervical cancer initially treated with surgery alone?
Assuming a PET is done, we treat one nodal region above the involvement (the entire common illiac nodes for pelvic only and paraaortic for common illiac involvement) along with vagina and paravgina with concurrent cisplatinum. The dose to involved node is 55 Gy in 25 fractions (equivalent to 58-60 G...
When, if ever, would you recommend hysterectomy after chemoradiation for patients with locally advanced cervical cancer?
We would never offer a routine hysterectomy unless a planned dose of RT can’t be derived for various reasons (very rare). If the patient has persistent disease after chemo RT, then they are considered for hysterectomy or exenteration based on extent of residual disease and surgical feasibility.
How would you approach second isolated vaginal cuff recurrence in a young patient with FIGO IA Grade 2 endometrioid endometrial adenocarcinoma who received EBRT+ interstitial brachy for her initial recurrence?
The dose delivered initially was on the lower side which may be a reason for recurrence. Normally we aim for 75 Gy EQ2 dose. This is our series for reradiation if exenteration is not an option Ling et al., PMID 30600093.
For a patient with cervical cancer s/p chemoRT, would you consider brachytherapy to downstage tumor to allow for hysterectomy rather than pelvic exenteration?
I am not clear as have not encountered this situation. I would complete chemo RT including brachy to definitive dose and reserve surgery as salvage if there is persistent disease 12-16 weeks after treatment.
When do you include the presacral nodes in post-operative XRT of endometrial cancer?
Cervical stromal invasion (pT2) or for definitive radiation for nodal or vaginal recurrence when treating the whole pelvis.The new Gyn postop atlas recommends if in including presacral to treat down to the pyriformis muscle. Historically, RTOG/GOG recommended S1-S3. PORTEC-3 used a 10mm in front of ...
How would you treat a recurrent endometrial cancer at the vaginal cuff that was initially FIGO 1A with no adj treatment, in a patient with actively treated scleroderma?
I would favor brachytherapy alone using MRI based planning with either a multichannel or hybrid applicator. Dose 6 Gy x 6 to CTV and higher dose (hot spots) to GTV.
How would you treat completed resected rectosigmoid recurrence of endometrial adenocarcinoma?
We have equally treated with chemotherapy for recurrence followed by involved site with RT in a few cases for isolated extended pelvic relapse. Overall outcome has been mixed.
How do you manage a distal vaginal recurrence of endometrial adenocarcinoma in a patient who had adjuvant external beam and cylinder brachytherapy boost to the top 4 cm of the vaginal cuff?
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
How would you manage a patient in her 50s with FIGO IA clear cell carcinoma of the endometrium with extensive LVSI and ITCs in an obturator node after 6 cycles of carbo/taxol?
I would favor EBRT plus brachy boost.Here is a review and our treatment philosophy Musunuru et al., PMID 35248784
How would you treat an endometrial cancer with pelvic sidewall nodes, patient s/p TAH/BSO but nodes were fixed and unresectable?
We would treat with IMRT and IGRT with concurrent cisplatinum based chemotherapy, with SIB boost dose to involved nodes (dose based on size and proximity of critical organs) followed by adjuvant chemo.