small bowel w/ T&O

[ACbubble]

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i have a patient with IIB cervix. her uterus sounds to 7.5cm. she has small bowel sitting right in front of the uterus. if i treat the entire uterus, her bowel dose is high. on imaging, she did not have disease extension up the uterus. Should i only treat a certain length of the uterus or treat the whole thing and accept the small bowel toxicity after optimization? rectum and bladder doses are fine and tumor responded well after EBRT to 45Gy.

 

[thesauce]

i have a patient with IIB cervix. her uterus sounds to 7.5cm. she has small bowel sitting right in front of the uterus. if i treat the entire uterus, her bowel dose is high. on imaging, she did not have disease extension up the uterus. Should i only treat a certain length of the uterus or treat the whole thing and accept the small bowel toxicity after optimization? rectum and bladder doses are fine and tumor responded well after EBRT to 45Gy.

I don't think you need to intentionally target the entire uterus. Are you 3D planning? You might just get an MRI and dose to the remaining gross disease. Or you could just dose to point A. Maybe put extra packing on the anterior side to cool it off.

Even if you dose to the initial PET+ disease, it doesn't sounds like the entire uterus is going to be your target, so I think that would be overkill.

 

[Neuronix]

We treat according to the GEC ESTRO working group recommendations: https://www.retroembrace.com/UserUpload/PublicDocuments/GEC ESTRO Recom II.pdf

These guidelines do not include the entire Uterus. Small bowel in the field hasn't been very concerning for us using these guidelines.