Cervical Cancer   

What are your volumes and dose/fractionation for external beam boost in lieu of tandem and ovoid or tandem and ring implant?

If so, what do you typically prescribe?

That nodal region has previously received 55 Gy in 25 fractions.

Would you consider this stage IVA (spread to adjacent organ) or IVB (spread to distant organ)? For instance, would the presence of direct lumbar verte...

Would you still discuss the option of parametrectomy/upper vaginectomy if they would have met the criteria for SHAPE?

Do you recommend completion hysterectomy after completion of child-bearing?

Pre-op stage was IB2, but post-op: tumor 4.5 cm, negative margins, no LVSI, 6/15 mm depth of stromal invasion, negative SLN.

Would you consider standard definitive chemoRT (EBRT + HDR brachytherapy)?

Cervical cancer FIGO stage IIIC2. Bloodwork shows elevated ESR and CRP. 

No LN dissection was performed as it was for a suspected CIN III. Final pathology showed +LVSI, -margins (>10mm), -parametrial extension, and 1.2mm...

The 4 cm cuff recurrence occurred 3 years after definitive treatment with hysterectomy and vaginal cuff brachytherapy to 21 Gy. The recurrence had a c...

What is your practice when you have a neutropenic cervical cancer patient undergoing chemoradiation?

If so, will you recommend it universally or only for certain patient population(s)?

If so, what dose/volume is prescribed? How do you account for motion?

This is a patient in her 70s who previously received 5040 cGy adjuvant EBRT alone to the pelvis. 

Aside from limit due to extent of her hysterectomy, the patient's disease does not otherwise satisfy Peters' criteria

Consider treatment of stage IVB cervical cancer with systemic therapy and local pelvic radiation therapy as in Perkins et al., PMID 31810653.

Assuming patient is <45 years old with cervical, vulvar, vaginal, anal, or head/neck cancers, or with CIN/VIN/VaIN/AIN/oropharyngeal precancerous l...

Considering this is stage IV disease, do your recommendations for definitive or adjuvant treatment (after surgery) change?

MRI pelvis shows a 3.5 cm primary that appears infiltrative and without clear parametrial extension on MRI. Staging PET negative.  Is there any ...

If yes, would you consider a minimally invasive approach despite the LACC trial results? If no, what additional research/information is needed to cha...

Close but negative radial margins? LVSI? What fractionation/dose do you use for your vaginal cuff boost if used? 

ConCerv trial: Schmeler et al., PMID 34493587 

7 cm tumor limited to the cervix with no vaginal or parametrial invasion on exam and not lymphadenopathy or metastatic disease on imaging. Cystoscopy ...

Occult IB1 cervical SqCC found on simple extrafascial hysterectomy, with 4 mm deep stromal invasion and LVSI. Subsequent pelvic and para-aortic nodal ...

Could you discuss how you decide between IMRT or SBRT boost for a patient who is not able to receive intracavitary or interstitial HDR or LDR brachyth...

When would you use 5-fluorouracil instead of, or in addition to, cisplatin during chemoradiation?

When would you use 5-fluorouracil instead of, or in addition to, cisplatin during chemoradiation? When, if ever, would you offer adjuvant hysterectomy...

Ideally, treatment should be completed in 56 days (preferably < 50 days). If there has been a significant delay to brachytherapy (>2-3 months) d...

If a patient presents with metastatic disease (by virtue of extensive PA nodal burden, mediastinal/SCV involvement, no solid organs) but received urge...

Do you include pembrolizumab with platinum-taxane + bevacizumab or reserve it as a second line option?

SIBs of 55-57.5 Gy in 25 fractions are frequently mentioned with bowel volume constraints at this dose, but assuming there is no bowel nearby (e.g., b...

Would you consider additional EBRT or vaginal cuff HDR in a patient with previous tx with EBRT (45Gy) + HDR (30Gy) for a R1 resection with a radial ma...

What are the pros and cons of using uterine artery embolization with regard to how it may affect the efficacy of radiation (+/- chemotherapy)?

Are there any criteria you use to preferentially recommend primary chemoradiation instead of primary surgery?

Assuming minimal toxicities except fatigue from long, recurrent infusions.

Do you increase EBRT or brachy dose by a certain amount based on interval? 

Do you recommend upfront diversion? Are there unique planning considerations such as the inability to use bladder filling? How do you boost? What are ...

Assuming the nodal assessment is minimally invasive and the patient is otherwise healthy without postoperative complications.

Consideration for localized therapy alone vs. localized therapy + systemic chemotherapy. 

Do you try to keep Hb> 10 or 12? Or somewhere in between? 

Patient is 38yo, has a history of narcotic abuse, and may have an undiagnosed personality disorder.

Is the QuadShot a possible option?

Could EBRT lead to rupture of the cyst?

This patient has pulmonary nodules that are too small to characterize.

Previously received pelvic EBRT and intracavitary brachytherapy. IORT was administered to the node-positive side wall at the time of exenteration.

Initially treated with definitive chemoRT but recurred with distant mets. Completed 6 cycles carb/tax/bev with minimal toxicity. Excellent performance...

Lung is biopsy proven met cervix, SBRT is planned. 

Patient did not previously receive para-aortic radiation. Considering RT vs RT  + chemo vs chemo alone

Recurrence was 2cm and PET confirmed local. Excision with positive margins. Current plan for salvage whole pelvic RT and vaginal cuff brachytherapy +/...

If confirmed neuroendocrine and PD-L1 pending, how would you treat?

In  patient with PD SCCA 15mm transverse;  5/20mm invasion; LVSI focally present; margins negative;  0/15 Left pelvic and 0/14 right pe...

What dose and technique do you use and how do you integrate the subsequent definitive treatment plan?

The recently released STARS phase 3 RCT found improved DFS, decreased distant recurrence, with reduced toxicities for chemotherapy (cisplatin + taxol)...

Despite the LACC trial, this year's SGO had many posters and discussions around MIS for early cervical cancer. If you offer MIS, what are the key ele...

Margins negative, no LVSI, PET/CT negative.

How would you factor in a patient with profound thrombocytopenia?

Paraaortic nodes positive to left renal vein

Would PET-positive pelvic or paraaortic lymph nodes change this recommendation?  

Currently 7 weeks pregnant, diagnosis based on CKC

ex. in a patient with pulmonary micronodules, inguinal, pelvic, PA nodes

Patient is currently 7 weeks GA with 1.5cm visible lesion. MFM recommends 13wk CKC vs LEEP with cerclage at that time. 

Particularly with IMRT when delineating volumes.

Lesion measures 2cm and PET is otherwise negative.

Patient with stage IIB cervical cancer treated 8 years ago, now with large (>10cm), isolated, symptomatic recurrence involving the left SCL and med...

Would you consider SBRT or brachytherapy?

What factors affect this decision?

Small bowel is usually the dose limiting OAR while planning cervical HDR brachytherapy. Having the bladder empty during treatment planning and deliver...

This has been a common practice in the community. Is there a benefit for certain patients?

What dose/fractionation would you recommend?

Margins are negative.

Patient being treated for cervical cancer noted to have a < 1 cm posterior vaginal fornix defect with a small focus epiploclia herniating into the ...

The limited data on MDA (minimum deviation adenocarcinoma) suggests it has a worse prognosis, but it is hard to disentangle this from stage, as it is ...

Would there be a substanital increase in the risk of toxicity using such a scheme?  We frequently have patients who have to travel long distance...

Would you be more or less likely to use a cisplatin-containing regimen if a patient had previously responded to chemoradiation with concurrent cisplat...

What chemotherapy and sequencing with radiation therapy would you recommend? IS surgery a component of the treatment?

Does the phase II KN-158 provide sufficient evidence to change management?

Should this be done at the time of recurrence or after failure of 1st line therapy for recurrence?

Do you have an SUV cutoff for physiologic activity of the ovary?

Do you cover common iliac nodes (L3/L4) or keep field edge at L4/L5 to reduce bone marrow toxicity? 

If so, what indications would you use other than Peters criteria?

Do you use a trimmed 10 mm expansion on HR-CTV? Do you also include the entire initial extent of disease? How much does your IR-CTV coverage affect yo...

What dose would you use?

A literature search indicates that most port site recurrences are managed fairly aggressively with chemoRT or RT doses 45-66 Gy. This is understandabl...

Sequentially or do you integrate the cuff brachy with the EBRT and if so what schedule, BIW, weekly, etc?

For example, a patient with cervical or anal SCC who has missed many treatments due to side effects, low blood counts, hospitalizations, or non-compli...

Do you add an IMRT boost with possibly vaginal brachytherapy?

What are your specific protocols for monitoring and for dosing narcotics and sedatives?

In the setting of a negative lymph node sampling, would you treat a full pelvis or mini-pelvis to compensate for lack of the appropriate surgery? Is a...

In patients who don't meet traditional criteria for adjuvant chemoradiation from Peters (GOG 109) and < 2 high risk factors from Rotman (GOG 92) fo...

What exactly do you contour and what is your dose constraint to that volume?

Does using something like a vienna applicator allow you to avoid dose escalation with more external beam? How do you recommend doing a classic pa...

Some classic references recommend the coverage of the entirety of the sacrum but the volume delineation guidelines for both seem to only cover the mos...

The most recent ABS guidelines don't discuss a dose constraint for the small bowel.

Does your strategy change if bladder invasion is present?

Do you treat PAs if pelvic nodes are positive? If common iliacs are involved? Only if there are positive PA nodes?