Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would focal clear cell features change your management for a grade 2 endometrial adenocarcinoma?
We do know clear cell predicts for worse outcome but don’t know volume required for it to be independent factor. In clinical trial they require at least 10 percent of volume to be clear cell not based on outcome but more on consensus. In our practice, if they have focal clear cell I would at least o...
In what situations would you perform a sentinel lymph node biopsy for cervical cancer?
At my institution we currently consider doing sentinel lymph node dissections for all patients with FIGO stage IA2-IB2 (2018 staging system) who have normal appearing nodes on CT scan. Our protocol utilizes indocyanine green (ICG) tracer and the near infrared detection with ultrastaging. If one side...
What is your strategy for treatment of FIGO IIB cervical cancer in a patient who poorly tolerated the first insertion and refuses subsequent insertions?
Psychological distress is common in cervical cancer patients treated with brachy; it's a painful and scary procedure. At another facility, hospital-based, I've used the OR for all of my tandem and ovoid insertions, with really optimal packing that gave good dose distributions and good patient comfor...
What is the longest interval to proceed with brachytherapy boost for cervical CA after EBRT?
I would proceed with brachytherapy even after a delay of 2-3 months as that is still better than no brachy and if local recurrence occurs, then the patient would need exenteration. Another option to consider, if imaging and scan show great response to EBRT, it is the possibility of a hysterectomy. I...
Is adjuvant treatment recommend for a 0.8cm serous endometrial CA confined to polyp s/p hysterectomy + surgical staging?
For surgically staged IA confined to polyp, the risk of recurrence reported in literature varies but on average, appears to be low and recent ESGO guidelines favor no treatment.
What is your technique to calculate the vaginal surface dose in gyn intracavitary brachytherapy?
The limited published data on image based brachytherapy has not found any dosimetric correlate of upper vaginal morbidity. The traditional point dose tolerence has underassessed tolerence of the upper vaginaThe recent multi-institutional EMBRACE study with different techniques and dose of cervical b...
What is your approach to a cervical SCC patient in which you're unable to properly place a T&O, due to obliterated cervical os, after completion of EBRT?
In our experience this is an extremely rare circumstance if the implant is done with ultrasound guidance--certainly <1% of cases. Depending on your level of experience and confidence, it may be worth referring the patient to a more experienced brachytherapist. That said, there are rare cases, partic...
How do you match a para-aortic field to a previously irradiated whole pelvis field in a woman with PA nodal failure after definitive chemoRT for cervical cancer?
We try to treat entire PA region and match to pelvic field (match two 50 percent isodose line) with .5 to 1 cm of safety factor based on nodal location
How do you treat endometrial cancer in the setting of a pCR after neoadjuvant chemotherapy?
There is no data to guide. I would favor pelvic RT based on initial stage IIIB disease. We, at our institution, usually treat these patients with neoadjuvant chemo RT followed by surgery.https://www.ncbi.nlm.nih.gov/pubmed/25218303
Are you using the new FIGO 2018 staging or waiting until it is incorporated into the next AJCC edition?
It will take 6-8 months for the incorporation into AJCC. Since our tumor registry follows AJCC, we are waiting for it to be done for uniformity of reporting.