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Topics:
Radiation Oncology • Gynecologic Cancers • Cervical Cancer • Medical Oncology • Re-irradiation
How would you manage a recurrent cervical cancer previously treated with vaginal cuff brachytherapy and has had a complete response to chemo-immunotherapy?
The 4 cm cuff recurrence occurred 3 years after definitive treatment with hysterectomy and vaginal cuff brachytherapy to 21 Gy. The recurrence had a complete clinical response on PET and MRI post systemic therapy. Initial plan was 45 Gy to pelvis followed by interstitial, but I’m uncertain how much beyond 45 Gy is necessary.
Answer from: Radiation Oncologist at Community Practice
We have no data suggesting a long-term cure with immunotherapy.
In this unfortunate situation, I would be comfortable going well beyond traditional tolerances. The patient has already locally failed one course of brachytherapy and a lesser dose would unlikely be curative. I would deliver 45 to 50 g...
Answer from: Radiation Oncologist at Academic Institution
I agree with the answers above.
I would aim for an EQD2 of 65-70 Gy for this course for the primary tumor. However, would favor 45 Gy to the pelvic nodes.
I would recommend interstitial brachytherapy, especially if the recurrence is 3-4 cm. I often prescribe 6-6.5 Gy x3 fractions with brachytherap...
Thanks for that excellent advice. How would you in...
I would aim for the highest safe dose looking at O...
Thanks again!