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- Nov 28, 2005
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I have a very challenging mid-50's female, previously healthy and good performance status with FIGO Stage IIIB SCC of cervix. Disease extended to lower vagina and was wrapping around the uterus essentially and into the adnexa. By MRI, was intimately associated with both bladder and rectum, but no clear invasion by imaging nor by exam.
She was treated with 2c of Carbo/Taxol and had an excellent clinical response. Plan was for standard chemoRT and brachy, however she sought alternative therapies and has been very resistant to starting treatment..now nearly 2 months since completion of the 2c of chemo.
I saw her as a second opinion (I was not involved with the above) and the mere mention of brachy nearly had her run from the clinic. I emphasized that time is of the essence and she needs to start yesterday, last week, last month! She believes that the excellent clinical response she had was, of course not the chemo, but the alternative therapies she has been taking.
I think I can twist her arm to do chemoRT but no way on brachy. She just will not do it and I think would go AWOL on us if that is the only option. I have never had this happen, so would love to hear what others would do in this situation:
1) Present only the SOC option of chemoRT with brachy
2) Start with chemoRT and hope you can twist her arm for brachy after she earns your confidence, but also knowing that with this patient, it really does seem very unlikely
3) Start with chemoRT, boost what you can with EBRT afterward
4) other ideas?
She was treated with 2c of Carbo/Taxol and had an excellent clinical response. Plan was for standard chemoRT and brachy, however she sought alternative therapies and has been very resistant to starting treatment..now nearly 2 months since completion of the 2c of chemo.
I saw her as a second opinion (I was not involved with the above) and the mere mention of brachy nearly had her run from the clinic. I emphasized that time is of the essence and she needs to start yesterday, last week, last month! She believes that the excellent clinical response she had was, of course not the chemo, but the alternative therapies she has been taking.
I think I can twist her arm to do chemoRT but no way on brachy. She just will not do it and I think would go AWOL on us if that is the only option. I have never had this happen, so would love to hear what others would do in this situation:
1) Present only the SOC option of chemoRT with brachy
2) Start with chemoRT and hope you can twist her arm for brachy after she earns your confidence, but also knowing that with this patient, it really does seem very unlikely
3) Start with chemoRT, boost what you can with EBRT afterward
4) other ideas?