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Brachytherapy vs whole pelvic irradiation for Ia UPSC/clear cell with isolated tumor cells in node

zsazsa1
Posts: 311
Joined: Oct 2018

So I went for a consult with radiation oncologist at the other major hospital in my city.  Recap - FIGO Ia, 20% myometrial invasion, +LVSI, only two sentinel nodes taken, one had isolated tumor cells.  Visual inspection was grossly normal, pelvic wash negative, omental biopsy negative.  I'm struggling with whether or not to have just intravaginal brachytherapy vs whole pelvic radiation.

The radiation oncologist whom I saw today went through the pros and cons of standard care (just vaginal brachytherapy), vs whole pelvic radiation, vs intensity modulated radiotherapy (IMRT) which tries to only hit the nodes.  After an in-depth discussion, I asked him what he would do if it were his own wife.  He sighed, and almost immediately said, "Whole pelvic radiation".

CT chest, abd, pelvis on Monday.  I'll decide after the results of that are in.

LisaPizza's picture
LisaPizza
Posts: 208
Joined: Feb 2018

I would pstsonally want coverage of thw lymph nodes, but that's nit necessarily a rational opinion ... I'm a scaredy cat. 

BluebirdOne's picture
BluebirdOne
Posts: 194
Joined: Jul 2018

My dx is almost exactly the same as you, except I had no node involvement. I also have LVSI, which offers a poorer prognosis for UPSC, no matter the early stage. I know they don't upstage LVSI, but it sure seems like it should have more weight given to it besides a poorer OS, which indicates that it is certainly not a benign factor. I had 4 chemo, 3 Brachy.  They decided to hold off on whole pelvic radiation for me to be able to save it for a recurrence. Brachytherapy, as you probably know, only radiates the vagina, no nodes or any other pelvic tissue. I would definitely want to the whole pelvic radiation if I had node involvement, just to be sure of getting a chance to kill any remainder cells. It is obvious to me, a non-medical person, that a few errant cells could be floating around or attaching themselves to organs, that are too small to detect, giving us 1a UPSC LVSI people a false sense of security which also explains why some 1a USPC recur. OTOH, pelvic radiation has very serious short and long term side effects that can occur.  The fact that there are multiple avenues of treatment makes the decision very difficult. Good luck on Monday and let us know what you decided. 

xxoo

Denise 

Ribbons's picture
Ribbons
Posts: 73
Joined: Jan 2019

i have decided on 3 brachytherapys only. I had 22 lymph nodes taken out and all were negative. I did have slight LVSI, my Dr. Said some cells were on the on ramp but hadn’t gotten on the freeway yet, lol. I really want nothing to do with external radiation at this time, hope it stays that way.

zsazsa1
Posts: 311
Joined: Oct 2018

Really, the standard for me would be brachy only.  I too cannot help but feel that whole pelvic gives me a better chance at OS.  Just had the CT.  The results of it may make all this moot.

LisaPizza's picture
LisaPizza
Posts: 208
Joined: Feb 2018

Time to wait, how fun (not). Sending good vibes.

BluebirdOne's picture
BluebirdOne
Posts: 194
Joined: Jul 2018

Let us know how it turned out. 

zsazsa1
Posts: 311
Joined: Oct 2018

Penn radiation oncologists are recommending IMRT.  They say it doesn't only target the nodes, does whole pelvis, with less toxicity to bowel and bladder.  They said if I can't get it in Hartford, that there's someone at Yale to do it.

zsazsa1
Posts: 311
Joined: Oct 2018

Hartford radiation oncologist says he does IMRT for endometrial and cervical cancer all the time - that it is now standard of care.  Yale can't fit me in for a consult until the end of the month.  Plus Yale is an hour away.  Hartford is ten minutes.  I'm going to go with Hartford for IMRT.  Sometimes you just have to make the decision, and jump in.  The way I refer to the treatments, once you make the decision, is that it's like riding a roller coaster.  You just have to strap yourself in for the ride, and give over control to the operator.  Hopefully, this is the last ride I'll have to take!

Kaleena's picture
Kaleena
Posts: 1935
Joined: Nov 2009

When it came for me to have radiation, my gyne/oncologist wanted me to have whole pelvic radiation.   However, my radiation/oncologist said he didn't want that.   DUe to how much I scar, my radiation oncologist said that the long term pelvic radiation would be more detrimental to me.  So they decided on only brachythereapy.

The long term effect of the brachytherapy gave me a ureter blockage on my left side, but that was like 8 years after initial treatment.   And recently (April 2018) (13 years later)I had major surgery due to scarring and recurrence.   Still no further treatment other than surgeries.

I feel that if I had the pelvic radiation I would have needed this surgery much sooner than I did.  

But of course, everyone is different and circumstances are different.  

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