Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the biggest mistake people make when using IMRT to treat cervical cancer?
I can't say for sure what the biggest mistake people make is, but some common issues I see when reviewing others' contours are: Using insufficient margins around the vessels when contouring the nodal volume (CTV) Using insufficient planning margins around the vaginal cuff (postop) or cervical mass/u...
What is the role of parametrial and pelvic side wall boosts in the setting of volumetric brachytherapy for locally advanced cervical cancer treated with either 3DCRT or IMRT?
The rationale behind the parametrial/side wall boost could be one or both of below 1. Treating the parametrium 2. Boosting involved pelvic nodes If it's done for an additional boost dose to the involved nodes, then the nodes should be contoured and dosimetry should be done to ensure coverage of invo...
How would you approach the management of a patient with locally advanced cervical cancer as well as synchronous endometrial adenocarcinoma?
The short answer is--treat both malignancies with a therapeutic plan that addresses them both. While the question fails to provide the details necessary to navigate the particular situation, some guiding principles can be asserted. 1. Intensity of therapy should be proportionate to the more dangerou...
How do you sequence vaginal cuff brachytherapy with EBRT for post-op endometrial or cervical cases that require both modalities?
We do sequential without any break after EBRT
In a patient with a vaginal cuff recurrence from endometrial cancer not amenable to interstitial brachytherapy, how would you boost after 45Gy?
If not amenable to brachy which is unusual in our practice, we would use IMRT boost to 66 to 70 Gy.
Would you offer adjuvant chemotherapy in addition to pelvic RT in a patient with fully resected pelvic recurrence of endometrial carcinoma?
For endometriod histology For nodal relapse, we do offer adjuvant chemotherapy, extrapolating from benefits seen in stage III disease, but not for isolated vaginal relapse.
Would one expect any significant response of pulmonary metastases with usual dosage of weekly cisplatin during definitive chemoRT for cervical cancer?
This is a great question that we have definitely discussed at our tumor board. Any systemic therapy has the potential to create a response to pulmonary metastasis, however dosing, timing, and duration of treatment all play into how much response is expected. In this setting, I would definitely want ...
What indications do you use to prophylactically treat para-aortic lymph nodes in cervical cancer?
The answer to this question is not simple although there are some general rules that we use. First, I should mention that for patients with locoregionally advanced disease, we now usually treat to the bifurcation of the aorta as a minimum. This generally puts the upper border close to L3/L4. We bega...
How do you decide whether to treat proximal vs. entire vaginal cuff with intracavitary brachytherapy in early-stage endometrial adenocarcinoma?
At M.D. Anderson - we never treat the entire vagina for early stage endometrial carcinoma. In fact, we only treat the proximal 2.5 to 3.0 cm of the vagina in most case but may increase with by 1.0 cm for patients with papillary serous or carcinosarcoma histology with brachytherapy. We have excellent...
In a pre-menopausal female with cervical cancer, would you boost a hypermetabolic ovary on PET?
Hypermetabolic ovary is very common and physiologic in premenopausal women and I would not boost that area. MRI pelvis can confirm benign nature of this uptake