The hits keep coming (locally advanced cervical)

[RadRadRad]

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I’m happy to refer my cervix patients out. I don’t want to do the brachy. I can’t send them away fast enough.

haha
My typical cervix brachy exoerince
-schedule patient for 5 fractions. Anticipate coming to OR at 630am 7 times. 5 treatments and 2 no shows .

 

[communitydoc13]

I don't understand your first line. When are you going to SBRT in this scenario if not in lieu of brachytherapy?

Sorry, should have been more clear. I meant that one should not choose external beam over brachy when brachy is a reasonable option. EBRT should always be s distant plan B after consideration of brachy and should always be presented as such to the patient.

All of my cervical patients are encouraged to go to a brachy referral and I coordinate all of this for their convenience. I always communicate the criticality of the brachy component. Nearly all of my patients who only get EBRT have been evaluated by a brachytherapist.

I didn't see anyone link the NCBD and SEER analysis.

I would consider the SEER analysis to be about as meaningful as any SEER analysis in terms of clinical outcomes (almost not at all) but the trends are concerning (marked decrease in brachy utilization). Also, some indication of downward trends in outcomes in stage II cervical cancer over time in the US is very concerning. (Is this due to decreased brachy utilization or the wrong implementation of minimally invasive surgery for these patients? I don't know.)

Regarding anticipated, prospective changes in evidence based management of cervical cancer in the era of IO and markedly improved response for selected patients? I would anticipate that brachy itself would perhaps be the preferred modality to preserve as we move to radiation de-escalation or planned triple modality therapy.

Of course, the goal will be a pathologic complete response and elimination of XRT altogether.

 

[ramsesthenice]

I end up doing SBRT boost with MR guidance once or twice a year for extenuating circumstances. I really push the conformality and let it get hot to make it as Brachy-like as I can. Offhand, I can’t recall any that failed locally or had unacceptable toxicities. I suspect that it’s probably pretty doable in patients with the right anatomy as suggested by Palex. However, until such time there is compelling data to suggest otherwise, I’m with Evil and am inclined to consider Brachy the SOC.