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What is the optimal approach for a younger female with borderline resectable cervix cancer who may need adjuvant radiation, in light of a medical history significant for ulcerative colitis?
MRI pelvis shows a 3.5 cm primary that appears infiltrative and without clear parametrial extension on MRI. Staging PET negative.
Is there any role for induction chemotherapy?
Would the specifics of prescription and technique used by adjuvant vs. definitive radiation make you favor one approach over the other?
Would your assessment change with how well the patient's colitis is controlled on biologic agent?
Answer from: Radiation Oncologist at Community Practice
It all depends on the colitis status on therapy including the extent and response to ongoing treatment.
No induction chemo.
Either radical hysterectomy with the possibility of adjuvant RT or definitive RT based on colitis status.
If high risk with RT, would proceed with surgery.
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Answer from: Radiation Oncologist at Community Practice
I would not use induction chemotherapy. If the patient is likely to require adjuvant RT with or without sensitizing chemotherapy, definitive chemoradiation is preferable. Triple modality toxicity should be avoided when possible. Ulcerative colitis alone, while associated with more side effects would...
Comments
Radiation Oncologist at Weill Cornell Medical College
Agree, no induction chemo. Will lean towards Chem...
Agree, no induction chemo. Will lean towards Chem...
Answer from: Radiation Oncologist at Community Practice
Agree with @Sushil Beriwal and @Lane R. Rosen.
I would not recommend induction chemotherapy - there is no evidence supporting such approach.
If, based on initial exam, pathology, and imaging, it appears that the patient will require adjuvant treatment, then we would consider treating the pat...
Answer from: Radiation Oncologist at Academic Institution
I'm not entirely sure why the patient is considered a borderline surgical candidate. 3.5 cm on imaging without parametrial extension on MRI with a negative PET/CT puts a very low likelihood of ending up requiring adjuvant chemoRT.Adjuvant RT alone to 50.4 Gy as per GOG 99 using IMRT/VMAT would cause...