Gyn Endometrial Special
Recurrent after Surgery Alone
- EBRT + VB
- 60 Gy to entire surface of vagina (dose to vaginal mucosa)
- 75 Gy dosed to the tumor
- for < 5 mm deep lesions vaginal cylinders (dosed to 5 mm depth)
- for ≥ 5 mm deep lesions interstitial implant (dosed to tumor)
- vaginal cuff – 40% AS 5yS with XRT
- vagina with pelvic extenteration – 20% AS 5yS
- Hormones used with 20% of pts. responding (progestin, tamoxifen)
- Cispaltin and carboplatin based chemotherapy usually in combination with paclitaxel.
Medically Inoperable Early-Stage
- MR to assess stage
- Fletcher-Suit with one or two tandems or Simon-Heyman Capsules in combination with vaginal ovoids
- 70-75 Gy to point A with LDR
- Add EBRT to 45 Gy where appropriate
Uterine Sarcoma
Need Nodal Dissection
- mixed mullerian tumors of the uterus
- endometrial stromal sarcoma
Do not Need Nodal Dissection
- leiomyosarcoma
Adjuvant RT
- RT in patients with increase locoregional recurrence.
- high-grade tumor
- positive noes
- positive margins
- gross residual disease
Preoperative
- Whole pelvis (4000 cGy at 180 cGy per fraction) and tandem and ovoids (2500 mg-hr to uterus, 4000-5000 cGy surface dose to vagina) followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy.
Postoperative
- Whole Pelvis (5000 cGy at 170-180 cGy per fraction) and ovoids (4500-5000 cGy surface dose to vagina).
page revision: 8, last edited: 24 Jul 2008 16:49