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How do you approach boosting a vaginal cuff recurrence of cervical cancer with brachytherapy that is tethered to small bowel?
Interstitial implant was attempted under laparoscopic guidance (due to pre-brachy MRI showing potential bowel involvement). At the time of procedure, tumor was found to be densely adhered to a segment of small bowel. Lysis of adhesions was attempted, but was aborted with tumor was seen tethering the bowel to the upper vagina for fear of peritoneal seeding with further dissection.
Answer from: Radiation Oncologist at Community Practice
Tough case.
Controlling cancer is important.
MRI guided brachy and making sure GTV is adequately covered even if bowel wall gets that dose.
Warn the patient about bowel obstruction and the need to bypass in future.
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Answer from: Radiation Oncologist at Community Practice
An incredibly challenging case!
I would consider using TRUS to guide needles in addition to laparoscopic guidance and would advance the needles into the bowel if necessary to cover the GTV.
I would accept some under coverage of GTV along the bowel/GTV interface as long it's dosed to the tole...
Comments
Radiation Oncologist at Delaware Valley Urology Cancer Treatment Center
Because small bowel fistula formation is a serious...
Because small bowel fistula formation is a serious...
Radiation Oncologist at University of California Irvine Medical Center
Yes, that is what we tried prior to her brachy boo...
Yes, that is what we tried prior to her brachy boo...
Radiation Oncologist at Sunnybrook Health Sciences Centre
Did you proceed with brachytherapy? What was the h...
Did you proceed with brachytherapy? What was the h...
Radiation Oncologist at University of California Irvine Medical Center
We are planning to proceed with brachytherapy usin...
We are planning to proceed with brachytherapy usin...
Radiation Oncologist at Sunnybrook Health Sciences Centre
That sounds like a great plan! I agree with...
That sounds like a great plan! I agree with...
Radiation Oncologist at Affiliated Oncologists
+1 to your plan
+1 to your plan
Radiation Oncologist at Vanderbilt-Ingram Cancer Center
That plan sounds very reasonable - would consider ...
That plan sounds very reasonable - would consider ...
Radiation Oncologist at University of California Irvine Medical Center
Just to close the loop on this - I counseled the p...
Just to close the loop on this - I counseled the p...
Answer from: Radiation Oncologist at Community Practice
If a poor candidate for brachytherapy, can also consider upper vaginectomy with small bowel anastomosis following initial EBRT.
Otherwise, advance needles slowly with interval imaging to get optimal positioning without perforation. Can also consider transrectal US for needle advancement.
Answer from: Radiation Oncologist at Community Practice
The risk of fistula will be higher and should also be explained to the patient.
Depending upon the patient's risk tolerance, age, and performance status, the bowel may need to be underdosed.
Answer from: Radiation Oncologist at Academic Institution
I don't do gynecologic brachy anymore, but there once was an expandable applicator that looked something like a squid (can't remember the name of it) due to the multiple catheters extending down from the expandable fluid-filled head, but it allowed more customizable dose to the vaginal mucosa as you...
Comments
Radiation Oncologist at Vanderbilt-Ingram Cancer Center
The Capri balloon catheter (what you are describin...
The Capri balloon catheter (what you are describin...