Endometrial Cancer&nbsp;&nbsp;&nbsp;

Would you include a seroma in an adjuvant radiation field for post-op endometrial cancer?

Is there any particular reason to include or not include this in the treatment volumes?

What is the optimal interval between vaginal cuff brachytherapy sessions?

At our institution we often give 5.5 Gy x 4 fractions. There really does not appear to be a general consensus regarding timing. Interested in what oth...

5 Answers available

Is adjuvant treatment recommend for a 0.8cm serous endometrial CA confined to polyp s/p hysterectomy + surgical staging?

What are your top takeaways from SGO 2022?

10 Answers available

Do you modify your treatment for a patient with ulcerative colitis needing vaginal brachytherapy?

Would you offer adjuvant RT to a FIGO IV endometrial CA with pulm mets s/p hysterectomy with residual disease, then cCR to both sites after chemotherapy?

How do you manage a cT3bN0 endometrial cancer with large vaginal drop met s/p NAC and TAH/BSO with pCR?

Would you recommend whole pelvis as well as vaginal cuff brachytherapy?

What is your adjuvant therapy for node positive, low grade endometrioid endometrial adenocarcinoma?

How do you manage early stage I uterine serous carcinoma?

VC brachy, pelvic RT, +/- chemo? Does your management change if it is confined to the endometrium without myometrium invasion or if it is only ...

Would you offer adjuvant radiation in addition to chemotherapy for a patient with stage IIIC uterine carcinosarcoma with cervical involvement?

Do you give vaginal cuff brachytherapy or whole pelvis (or both), for patients with Stage III endometrial adenocarcinoma?

5 Answers available

What is the best method for ensuring that vaginal cuff cylinder is in proper position at each fraction?

In patients diagnosed with endometrial cancer who do not undergo SLNB or LND at the time of hysterectomy, what criteria is used to recommend completion surgery for LN assessment?

What is the longest acceptable interval between hysterectomy and vaginal cuff brachytherapy for high/intermediate risk endometrial cancer in the age of COVID-19?

When do you include the presacral nodes in post-operative XRT of endometrial cancer?

Would involvement of the PA nodes be an indication?

With vaginal cuff brachytherapy, do you treat to the surface or a depth and why?

What HDR dosing would you use in the neoadjuvant setting of endometrial cancer?

How would you treat a patient with pT1bN0 G1 endometrioid carcinoma with significant MMI (~80%) and +LVSI?

EBRT vs VB? She technically meets PORTEC2, but also meets GOG99 and GOG249 (for pelvic RT) and PORTEC4. NCCN recommends for IB grade 1 vaginal brachyt...

What are indications to add WPRT +/- PA field to chemotherapy for uterine serous carcinoma?

Is there a role for elective para-aortic nodal irradiation in endometrial cancer?

Is there any indication for ENI in early stage disease or in advanced stages, without pathologic confirmation or PET positivity or CT size criteria?

How would you approach second isolated vaginal cuff recurrence in a young patient with FIGO IA Grade 2 endometrioid endometrial adenocarcinoma who received EBRT+ interstitial brachy for her initial recurrence?

The patient was initially observed after radical hysterectomy due to young age, FIGO IA grade 2 disease. The patient had isolated, biopsy-proven vagi...

Would you offer consolidative radiation for oligometastatic uterine serous CA s/p surgery and chemotherapy with complete response?

How do you plan for excess nonconforming vaginal tissue with a HDR cylinder?

In women receiving HDR intracavitary brachytherapy to treat the vaginal cuff, how do you overcome the challenge of excess lateral vaginal tissue ("dog...

Do you recommend adjuvant treatment for nodal isolated tumor cells in an otherwise low-risk endometrial cancer?

Would you give adjuvant therapy after diagnosis of presumed stage IA, 5cm, ER/PR+ uterine adenosarcoma on a total hysterectomy with bilateral salpingoopheretomy without staging?

No sarcomatous overgrowth seen.

How would you deliver/time radiation for a patient with IIIC1 serous endometrial cancer who is HER2+?

Planning carboplatin/taxol/trastuzumab. Cervical stromal invasion on path. Looking for pelvic vs brachy and timing with chemotherapy.

How would your follow-up change for a patient, non-surgical candidate, with endometrial cancer treated with definitive radiation?

What normal tissue constraints do you use, if any, in patients receiving vaginal cuff brachytherapy alone?

How would you manage a clinically inoperable, stage IIIB, MMR deficient uterine cancer?

Tumor felt to be technically unresectable due to extensive cervical/parametrial involvement. ER/PR and HER2 testing are pending.

Would uterine serosal involvement change your adjuvant treatment recommendation for a patient with Stage II grade 2 endometrial cancer?

Tumor traverses the myometrium to focally involve the serosa; 1/6 sentinels with ITC and the rest negative.

How does number of ITC influence your approach to adjuvant RT for a surgically staged 1B endometrial cancer meeting HIR criteria?

Pt is 73yo, Grade 1, 81% invasion, MELF like features, foci of LVSI, and 47 ITCs identified.

How would you sequence chemotherapy and radiotherapy for a patient with stage IIIC1 serous endometrial carcinoma?

HER2 status is pending

Would you change your approach to adjuvant radiation for an incompletely staged, at least IB, grade 1 endometrial cancer, if a uterine perforation occurred at time of surgery?

Pt is 69yo, tumor 1.4cm, negative LVSI, ER/PR +

5 Answers available

Would the presence of multifocal LVSI change your adjuvant treatment recommendation for a surgically staged IA dedifferentiated endometrial carcinoma?

Does not technically meet high intermediate risk criteria.

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 guarante...

How would the presence of micro-metastatic disease in multiple sentinel pelvic lymph nodes change your recommendation for adjuvant therapy in a patient with otherwise stage I endometrioid adenocarcinoma?

How would you manage a recurrent uterine leiomyosarcoma, now status post secondary cytoreduction, with no gross residual disease?

Would you consider adjuvant chemotherapy, radiation therapy, hormone therapy, or surveillance?

How do you manage early stage uterine carcinosarcoma?

Do you give cuff and chemo or pelvic CRT or chemo alone?

How do you sequence chemotherapy with radiotherapy for advanced endometrial cancer?

Would you recommend adjuvant therapy for a 1A grade 2 endometrial adenocarcinoma with MELF pattern, and ITCs in one pelvic lymph node?

What adjuvant therapy would you offer a patient with Stage II uterine serous carcinoma without lymph node sampling?

How would you manage recurrent endometrial cancer limited to pelvic and inguinal nodes in a patient with no previous radiation?

How would you manage a Stage IB endometrioid endometrial cancer, status post staging surgery, with a rapid vaginal recurrence <1 month post operatively?

This case involves an impressive ‘high volume’ vaginal recurrence and patient was not originally planned for adjuvant therapy. Concerned t...

When would you add a vaginal cuff brachy boost to external beam radiation for uterine carcinosarcoma?

Would you offer EBRT alone or EBRT with vaginal cuff brachytherapy after surgery and chemotherapy for stage III (T3N0) carcinosarcoma of the uterus? ...

Do you recommend concurrent chemotherapy with XRT for inoperable patients with stage I-II high-risk endometrial carcinoma?

Ie for patients who are inoperable due to comorbidities?

Do you offer pelvic radiation for endometrial cancer with ITCs in the node(s) and no other high or intermediate risk factors?

What dose is needed for salvage RT for recurrent endometrial cancer in untreated PA region (who has received pelvic RT) after good PET response to systemic therapy?

For a patient with good response to immunotherapy (unable to receive chemotherapy due to kidney function, comorbidities) where previously avid LN have...

Do PORTEC-3 and GOG-258 change your approach to managing patients with high-risk or node positive endometrial cancer?

http://abstracts.asco.org/199/AbstView_199_180760.html http://abstracts.asco.org/199/AbstView_199_187537.html

Do you offer vaginal cuff brachy alone, vaginal cuff brachy and chemo, or WPRT for surgically staged IB grade 3 endometrial cancer?

Does the GOG 249 abstract guide you one way or the other?

For a patient with recurrent endometrial cancer involving the vagina with a good response to EBRT (<5mm residual), how would you prescribe adjuvant brachytherapy with a cylinder to the entire vaginal length?

How successful is IVF after definitive radiation therapy to the pelvis for endometrial cancer?

How do you counsel a pre-menopausal female with endometrioid cancer desiring definitive RT with egg harvesting and IVF for fertility preservation inst...

Would you offer adjuvant chemotherapy in addition to pelvic RT in a patient with fully resected pelvic recurrence of endometrial carcinoma?

With COVID-19 worries, are you more likely to offer women with endometrial cancer vaginal cuff brachytherapy over EBRT?

In a patient with a vaginal cuff recurrence from endometrial cancer not amenable to interstitial brachytherapy, how would you boost after 45Gy?

Insurance authorization for protons is pending, but if the patient cannot have protons would you treat with standard fractionation to ~70Gy or conside...

In a surgically staged Stage II Grade 1 endometrial adenocarcinoma, with no other high risk factors, would you treat with brachytherapy alone or add on the pelvic RT?

NCCN recommends brachytherapy plus or minus pelvic RT for surgically staged Grade 1, Stage II patients, but these originally staged IIB patients were ...

Would you recommend radiotherapy for a para-aortic recurrence of endometrial cancer in a patient who previous completed surgery, chemotherapy, and WPRT?

How does the presence of microcystic elongated and fragmented (MELF) invasion impact post operative treatment of Stage IA FIGO grade 1 endometrial cancer?

How would you approach an inoperable, elderly, frail patient with high risk endometrial cancer?

How would you treat an endometrial cancer with pelvic sidewall nodes, patient s/p TAH/BSO but nodes were fixed and unresectable?

Would you consider EBRT or brachytherapy boost to the nodes? what dose would you recommend?

When do you use a vaginal cuff boost with pelvic RT for stage II endometrial cancer?

For the management of stage II endometrial cancer, NCCN says pelvic RT and/or vaginal brachytherapy. Do you ever add vaginal cuff boost to pelv...

Would you offer adjuvant radiation to a patient with uterine undifferentiated sarcoma s/p resection, vaginal cuff recurrence, and re-resection?

If so, would you treat the whole pelvis, cuff brachytherapy, or both?

Does the presence of a POLE mutation in endometrial cancer guide your recommendations regarding adjuvant radiation?

How would you approach a young patient with a locally advanced endometrial cancer with cervical involvement and a solitary bone metastasis?

What alternative boost methods (techniques / dose) do you recommend for a vaginal cuff boost after whole pelvis when imaging shows bowel adherent to the vaginal cuff?

Would the findings of a synchronous T1a ovarian endometrioid adenocarcinoma affect your treatment recommendation for a IB, G2 uterine endometrioid adenocarcinoma and LVSI?

How do you treat a Stage I endometrial squamous cell carcinoma?

MRI and cervical biopsy are negative for cervical involvement

Would focal clear cell features change your management for a grade 2 endometrial adenocarcinoma?

For a patient with vaginal adhesions/stenosis, do you recommend any other therapy besides a dilator?

Would estrogen cream be helpful in this scenario?

Do you continue Megestrol in a patient with inoperable endometrial cancer during definitive radiation therapy?

are there any positive or negative synergies from combined megestrol/RT treatment?

Would uterine perforation at the time of hysterectomy push you to recommend pelvic RT in a patient who would otherwise receive cuff brachytherapy?

Is obesity a risk factor for recurrence after definitive treatment for endometrial cancer?

At what point would you introduce the discussion of weight management, whether for risk reduction or overall health?

How do you decide on adjuvant therapy in a patient with a Stage IA uterine carcinosarcoma without any myometrial invasion?

The NCCN recommends either systemic therapy + brachytherapy or pelvic RT + brachy or brachy alone or observation. How do you decide among these option...

How would you treat a patient with a FIGO G1 pT1bN0 endometrial adenoCA involving the lower uterine segment with >50% invasion and a separate focus of disease found involving the endocervical mucosa with no cervical stromal invasion?

The disease involving the endocervix was felt to be separate and appeared like a drop metastases

Are you using the new FIGO 2018 staging or waiting until it is incorporated into the next AJCC edition?

What is the maximum time you would wait after hysterectomy to start RT for a FIGO II endometriod adenocarcinoma before cancelling treatment and saving for salvage?

How do you treat endometrial cancer in the setting of a pCR after neoadjuvant chemotherapy?

Female in her 60s who had presented originally with well-differentiated endometrioid adeno clinically and radiographically involving bilateral paramet...

How do you approach adjuvant therapy of serous intraepithelial carcinoma of the endometrium?

For a woman with complete resection of serous intraepithelial carcinoma of the endometrium, would you recommend adjuvant radiation or chemotherapy? Wh...

What factors do you use to determine whether to add brachytherapy to EBRT for IIIC endometrial cancer?

Current NCCN guidelines suggest that vaginal brachytherapy is optional, and there may be concern for over-treatment locally given competing risk of di...

Do you have any normal tissue constraints for endometrial cancer patients receiving EBRT and vaginal cuff brachytherapy?

Do you add chemotherapy to pelvic radiation and brachytherapy for an isolated vaginal cuff recurrence of endometrial cancer?

Are there any situations in which you would offer brachytherapy alone instead of whole pelvis RT +/- brachytherapy for an endometrial cancer vaginal cuff recurrence?

When do you offer observation for resected stage II endometrial cancer?

In what situations is it appropriate to offer observation (rather than VBT) to patients with stage II endometrial carcinoma who have had a radical hys...

How would you approach the management of a patient with locally advanced cervical cancer as well as synchronous endometrial adenocarcinoma?

What strategies have you found to be most helpful in improving patient compliance with vaginal dilator use after pelvic radiotherapy?

How does positive peritoneal washings factor into your treatment decisions regarding pelvic radiation and/or chemotherapy?

For example, in an otherwise intermediate risk localized endometrial cancer (Grade 2, FIGO IB)?

How do you decide whether to treat proximal vs. entire vaginal cuff with intracavitary brachytherapy in early-stage endometrial adenocarcinoma?

What clinicopathologic features do you typically consider?

What clinical and pathological factors guide your decision making when considering whether to recommend vaginal cuff brachytherapy following TAH/BSO for a FIGO stage IA or IB endometrial carcinoma?

Would you include a lymphocele in your IMRT treatment volumes for endometrial carcinoma?

If the post-operative simulation films reveal a significant lymphocele secondary to pelvic lymph node sampling, is it imperative that the entire lymph...

For which patients with stage IA nonsurgically staged endometriod cancer would you add pelvic RT?

The gyn oncs at my institution sometimes will not perform lymphadenectomy if biopsy indicates low risk disease. Would LVSI as sole adverse risk factor...

What is the optimal management of a pelvic sidewall recurrence of endometrial cancer in a patient who has not previously received radiation?

What is your technique to calculate the vaginal surface dose in gyn intracavitary brachytherapy?

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

What is the role of parametrial and pelvic side wall boosts in the setting of volumetric brachytherapy for locally advanced cervical cancer treated with either 3DCRT or IMRT?

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...

What are you posterior field borders for endometrial and cervical cancer 3DCRT plans?

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...

Do the number of lymph nodes removed in a non-Stage IA/FIGO 1 endometrial cancer case, affect your decision for WPRT v. vaginal brachytherapy alone?

Once endometrial cancer recurs after no chemo or XRT, is it curative or palliative?

Does hydroureter and leg edema alter your opinion?

What is the best treatment for a medically inoperable endometrial adenocarcinoma of the uterus FIGO 1, grade 1, type 1?

Brachytherapy, EBRT or both and what is the best dose?

What lessons can we learn from RTOG 0418 in how to best use IMRT to treat endometrial cancer?