Endometrial Flashcards
In general, what does EBRT target? What is the dose?
Pelvic radiotherapy should target the gross disease (if present), the lower common iliacs, external iliacs,
internal iliacs, parametria, upper vagina/para-vaginal tissue, and presacral lymph nodes (in patients with
cervical involvement).External-beam
doses for microscopic disease should be 45 to 50 Gy given in 1.8G fractions over 5 weeks
What does extended field target?
Extended-field radiotherapy should include the pelvic volume and also target the
entire common iliac chain and para-aortic lymph node region. The upper border of the
depends on the clinical situation but should at least be to the level of the renal vessels.
What is the dose for brachytherapy after hysterectomy when using ebrt??
high-dose rate brachytherapy, when used as a boost to EBRT doses of 4-6 Gy x 2-3 fractions prescribed to the vaginal mucosa at a depth of 0.5cm.( usually upper 2/3 of vagina
What is the dose of brachy alone after hysterectomy?
For high-dose rate vaginal brachytherapy alone,
The target for vaginal brachytherapy after hysterectomy should be limited to the upper vagina.
commonly used regimens include 7 Gy x 3 prescribed
at a depth of 0.5 cm from the vaginal surface or 6 Gy x 5 fractions prescribed to the vaginal surface.
Does adjuvant radiation affect overall survival for early stage endometrial cancer?
adjuvant RT improves pelvic control in patients with selected risk factors (and may improve
PFS), but RT did not improve overall survival in any of the trials.
However, many of these trials had limitations because most of the patients were low risk (ie, they had low-risk intrauterine pathologic risk factors). Thus, the trials were underpowered for patients with high-risk factors.
Regarding adjuvant RT for early stage disease, there are 4 RCT’s, how are they different in patient selection?
In 2 of these trials, the patients were not formally staged (Postoperative Radiation Therapy inEndometrial Carcinoma [PORTEC-1], Aalders). In the third trial
(ASTEC/EN.5), only 50% of the patients were thoroughly staged as partof a companion surgical protocol.
However, formal surgical staging was mandated for all patients in the fourth trial ([GOG] 99)
Did PORTEC1, Alder’s, ASTEC, or GOG 99 find in terms of local control?
The PORTEC-1 trial suggested that external-beam pelvic RT provides atherapeutic benefit in selected patients
Although RT significantly decreased locoregional
recurrence,The Aalders’ randomized trial found that RT reduced vaginal (ie, locoregional) recurrences but did not reduce distant metastases or improvesurvival.
(ASTEC/EN.5) suggestedthat adjuvant pelvic RT alone did not improve either PFS or overall survival
in patients with intermediate-risk or high-risk early-stage endometrial cancer, but there was a small
improvement in pelvic control.However, the ASTEC/EN.5 study is controversial: 50 % received vaginal brachytherapy. GOG 99: improved PFS, local control
Is it appropriate to offer vaginal brachytherapy instead of EBRT?
PORTEC-2 showed excellent and equivalent
vaginal and pelvic control rates with both adjuvant radiation approaches and no difference in overall survival.Given that vaginal brachytherapy
is associated with significantly less toxicity than pelvic RT, vaginal brachytherapy alone is a reasonable choiceBoth PORTEC-1 and PORTEC-2 specifically excluded patients
with 1998 FIGO stage 1C, grade 3
What is imrt? What are the benefits? Con ?
Intensity modulated radiation therapy
The prescription dose is conformed around the target tissue in 3D ( instead of 4 field technique) thereby reducing dose or radiation to normal surrounding tissue Con: longer time setting up treatment, no Head to head studies
