Cervical Cancer

Question 1

Risk of pelvic node involvement

Answer 1

“Rule of 15” ( Stage x 15)
Stage I = 15%
Stage II = 30%
Stage III 45%
.
.
Depends on
Stage
DOI
LVSI
Size

Question 2

classic 4 field 3D conformal borders

Answer 2

Sup: L4/L5
inf: 3cm below the lowest vaginal involvement or inf to obturator foramen
Ant: 1cm ant to pubic symphysis
Post: entire post sacrum

Question 3

What chemo is used for CRT

Answer 3

Cisplatin

Question 4

When is para aortic node included in PLNRT

Answer 4

> 1 pathologic node at common iliac or above as per EMBRACE II study

Question 5

Cervical cancer prognosis

Answer 5

IB1: 98-100%
IIB: 96%
III-IVA: 73-86%

Question 6

RTOG 07-24

Answer 6

AP-PA fields
Para-aortic nodes +ve: T11-T12
Common iliac nodes +ve: L1/L2

Question 7

EMBRACE II LN Borders

Answer 7

L2 or renal veins, 3cms above the highest involved para aortic nodes

Question 8

Vaginal dilators

Answer 8

4-6 weeks post radiation therapy to prevent stenosis

Question 9

AZO/Phenazopyridine

Answer 9

OTC medication that is excreted in the urine which provides topical analgesic effect (urinary tract mucosa)

Question 10

PLNRT 50Gy to 45 Gy

Answer 10

reduce long term GI toxicity by 50% (diarrhea)

Question 11

Histology

Answer 11

SCCa: 80%
Adenocarcinoma: 10-20%

Question 12

GOG 71

Answer 12

RT + Observation vs RT + TAH
No survival benefit with adjuvant TAH
No difference in toxicity.
Only pts with residual tumor post RT benefit from TAH

Question 13

FIGO staging studies included

Answer 13

Chest x-ray
IV pyelogram
Barium enema
Skeletal x-ray
Cystoscopy/proctoscopy

Question 14

GOG 123

Answer 14

Pre-op RT vs Pre-op CRT

Question 15

GOG 120

Answer 15

Chemotherapy regimens compared 3 types
Cisplatin vs Cisplatin/5FU/hydroxyurea vs Hydroxyurea alone
all patients had EBRT + Brachy
Cisplatin based chemotherapy had survival benefits!
No significant differences in toxicities

Question 16

RTOG 90-01

Answer 16

CRT showed 8 year OS improve and decreased disease recurrence.

Question 17

GOG 109
Intergroup 0107

Answer 17

Adjuvant RT vs Adjuvant CRT
Based on peters criteria they needed adjuvant therapy
CRT: Cisplatin + 5FU Q3weeks for 4 cycles
Cisplatin 70mg/m2; 5FU 1000mg/m2
.
.
.
10% increase in 4 year OS when CRT was used
71%->81%

Question 18

When is observation okay?

Answer 18

Post cold knief conization if they have
- negative margins
- no LVSI
- grade 1-2 disease
- DOI <1cm
- Tumor size <2cm
.
.
If they do not desire any more kids then consider extrafasical hysterectomy + Pelvic LND or EBRT + brachy

Question 19

Staging

Answer 19

Question 20

How to sim the patient

Answer 20

Place markers EUA to see the lower extent of vaginal disease

Question 21

Brachytherapy doses

Answer 21

35-45Gy prescribed to point A
Parametrial extension gets a 5.4-9Gy boost
Residual gross disease can get a 10-15Gy
EBRT + Brachy combined should be at least 80Gy

Question 22

Sedlis criteria is for cervical cancer patients

Answer 22

3 “S”
Space 1) LVSI
Stromal 2) 1/3 stromal invasion
Size 3) tumor size >4cm

Question 23

Tandem Brachy points

Answer 23

Question 24

What time frame should EBRT + Brachy be completed?

Answer 24

8 weeks