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How would you deliver pelvic radiation as cost-efficiently as possible for a patient with endometrial cancer?
In the unfortunate setting where you cannot get an underinsured patient whose policy does not cover radiotherapy started on treatment without guaranteeing self payment up front and a third party payor option would unacceptably delay treatment, what deviations (e.g., 5 fraction) are reasonable to minimize cost as much as possible?
Answer from: Radiation Oncologist at Academic Institution
I think that a 4 field plan to 45 Gy in 25 fractions without cuff brachytherapy would reduce cost without deviating from the standard of care. We would expect that to come with modestly more acute and chronic toxicity than IMRT. I think we need more evidence before a 5 fraction regimen could be reco...
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Answer from: Radiation Oncologist at Academic Institution
I agree with the above overall recommendation. However, I would like to know the reasons for the need for Post-op RT. Some factors could change the RT doses and/ or indication for brachytherapy.