Brachy Question - If You Do Brachy Can You Do External Pelvic Later If You Recur?

woodstock99

Hi Ladies - me again - sorry to be a pest. 

Does anyone know for certain if you do brachy only as initial post-op treatment, is external pelvic radiation an option if you have a local recurrence?   

I had one RO tell me yes, one tell me yes but at not at as strong a dosage as you would have had if you did external first and one tell me no you can't do external after brachy  (maybe that is why you get brachy after external if you do both?.   

I have to make a decision between the 2 and am leaning toward brachy for a number of reasons as I am told only a 2% difference in 5 year recurrence % but one reason in going that route was to hold pelvic radiation for future if needed for local recurrence but if that is not an option that chnages the decision making process.

I am in analysis paraylysis.  

Thanks.  

Tamlen

NCCN guidelines

If you haven't seen them yet, the NCCN Guidelines may be useful to you in seeing the recommended standard treatments. The table of contents on page 5 of the Guidelines will direct you to Chapter 4 or 5, depending on your type of uterine cancer.

NCCN Uterine Neoplasms which links to NCCN Guidelines version 3.2021

If you want to see specifically the spots in the document that mention brachytherapy, open the link to the Guidelines PDF in your browser, then CTRL-F (or CMD-F if on a mac) and type brachytherapy into the little search box, hit enter. It'll highlight all places it's mentioned and you can click to see each of them.

I haven't had experience with external radiation at this point so can't comment on sequence or brachy dosing, but I have seen a number of women on this forum refer to "saving external for use if needed later." I'm sure someone will come along here soon who can speak directly from their experience.

woodstock99

Tamlen said:

NCCN guidelines

If you haven't seen them yet, the NCCN Guidelines may be useful to you in seeing the recommended standard treatments. The table of contents on page 5 of the Guidelines will direct you to Chapter 4 or 5, depending on your type of uterine cancer.

NCCN Uterine Neoplasms which links to NCCN Guidelines version 3.2021

If you want to see specifically the spots in the document that mention brachytherapy, open the link to the Guidelines PDF in your browser, then CTRL-F (or CMD-F if on a mac) and type brachytherapy into the little search box, hit enter. It'll highlight all places it's mentioned and you can click to see each of them.

I haven't had experience with external radiation at this point so can't comment on sequence or brachy dosing, but I have seen a number of women on this forum refer to "saving external for use if needed later." I'm sure someone will come along here soon who can speak directly from their experience.

saving external for later

Thank.  Yes I have seen the NCCN guidelinees but question is about saving external for later. 

I know if one has external & brachy they always seem to do external first and then brachy sequence and there must be a reason for that versus other way around which also madfe me wonder about option to save external for later.  

 

 

BluebirdOne

That is exactly what my docs told me.

2018, dx 1a serous. LVSI. Treatment at Mayo Clinic. I had four chemos, 3 brachy, sandwiched in between the chemo. Reserving full pelvic in case of a recurrence. The NCCN guidelines outline the treatment options on page 46. "Radiation (internal and/or external)". The operative words being, and/or. Doesn't say when. My docs also said they wanted to reserve the EBRT because it can only be used once in any given area, and serous has a high rate of recurrence. Also in 2018, there were few options for treatment, primarily, surgery, chemo and radiation, now there are other treatments available if your qualify. These are questions that your GO and RO need to answer to YOUR satisfaction. Perhaps a second or third opinion? (sorry, I don't know if you have gotten those) I had a terrible experience getting dx and treatment initially, and I never hesitated to get a second opinion and immediate surgery at Mayo. Your questions are valid and easy enough for clarification, but we have to accept that there are few absolutes when dealing with this cancer. Good luck to you.

Denise 

woodstock99

BluebirdOne said:

That is exactly what my docs told me.

2018, dx 1a serous. LVSI. Treatment at Mayo Clinic. I had four chemos, 3 brachy, sandwiched in between the chemo. Reserving full pelvic in case of a recurrence. The NCCN guidelines outline the treatment options on page 46. "Radiation (internal and/or external)". The operative words being, and/or. Doesn't say when. My docs also said they wanted to reserve the EBRT because it can only be used once in any given area, and serous has a high rate of recurrence. Also in 2018, there were few options for treatment, primarily, surgery, chemo and radiation, now there are other treatments available if your qualify. These are questions that your GO and RO need to answer to YOUR satisfaction. Perhaps a second or third opinion? (sorry, I don't know if you have gotten those) I had a terrible experience getting dx and treatment initially, and I never hesitated to get a second opinion and immediate surgery at Mayo. Your questions are valid and easy enough for clarification, but we have to accept that there are few absolutes when dealing with this cancer. Good luck to you.

Denise 

Thanks .  Yes I have seen this document and page 46 regarding the options for my stage/grade.  I am 99% sure that I was told that oen reason to do brachy now was that I could keep external in back poccket if needed for later.  But when getting second opinions I thought I heard (as did my husband) one RO say yes but at a lower dosage so as not to overardiate and another RO say no you couldnt do external after brachy.  I am in analysis paralysis but need to make a decision so I thought someoen on here may have had extermnal after internal if they had a recuurence to confirm. I ahd breast cancer 6 years ago and it was not this complicated.  My GO now refers all my questions to the RO and I am only 4+ weeks post-op.  I am very frustrated.  Thanks.     

MoeKay

My Thoughts

I had both--external followed by internal radiation.  However, I know initially when I consulted with my RO, she and my GO were not on the same wavelength.  Due to the location of my tumor and my particular risk factors, my GO wanted me to get both types of radiation.  When I had my consult with the RO, she only discussed the external radiation with me.  She initially said I would get 28 external treatments.  Then my GO and RO discussed my case and after they hashed things out, the RO agreed that my treatment plan should include both types of radiation.  But when she added the brachytherapy to the treatment plan, she also decreased the number of external treatments from 28 to 25.  So while this doesn't really address your issue, I think it might be some indication that if you've previously had brachytherapy, that would be taken into consideration in determining the total radiation dose for any subsequent EBRT.  I would confirm how prior brachytherapy would affect your total dosage of EBRT, should you ever need it, with the ROs with whom you've consulted.   

woodstock99

MoeKay said:

My Thoughts

I had both--external followed by internal radiation.  However, I know initially when I consulted with my RO, she and my GO were not on the same wavelength.  Due to the location of my tumor and my particular risk factors, my GO wanted me to get both types of radiation.  When I had my consult with the RO, she only discussed the external radiation with me.  She initially said I would get 28 external treatments.  Then my GO and RO discussed my case and after they hashed things out, the RO agreed that my treatment plan should include both types of radiation.  But when she added the brachytherapy to the treatment plan, she also decreased the number of external treatments from 28 to 25.  So while this doesn't really address your issue, I think it might be some indication that if you've previously had brachytherapy, that would be taken into consideration in determining the total radiation dose for any subsequent EBRT.  I would confirm how prior brachytherapy would affect your total dosage of EBRT, should you ever need it, with the ROs with whom you've consulted.   

Thank you.  Yes perhaps you

Thank you.  Yes perhaps you get a stronger dose of brachy if you are doing it first and if external is needed down the road it may need to be adjusted.  How far apart did you do your brachy treatments.  I have read the more they arre spaced apart the lesser the short term side effects are.  

Fridays Child

Might depend on doctor's thoughts

When I had my original diagnosis in 2012, I had surgery followed by brachytherapy.  When I was diagnosed with a recurrence in 2018, I had external radiation to the area of the recurrence, the left hip and left pelvic area.  So yes, it is possible to have external radiation after brachytherapy.  They didn't say anything to me one way or the other about whether the dosage was less than it might have been without the brachytherapy.

Good luck with your decision.

MoeKay

woodstock99 said:

Thank you.  Yes perhaps you

Thank you.  Yes perhaps you get a stronger dose of brachy if you are doing it first and if external is needed down the road it may need to be adjusted.  How far apart did you do your brachy treatments.  I have read the more they arre spaced apart the lesser the short term side effects are.  

Answer to your question about my brachytherapy

I received my brachytherapy all at once as a hospital inpatient in isolation for two days.  Back in 1999 when I was treated, that was standard of care.  I went into the hospital a week after finishing EBRT.  According to the American Cancer Society's website, the type of brachytherapy I had, low-dose rate (LDR), isn't commonly used in the United States now.  If you decide to go with brachytherapy, you will be getting the high-dose rate (HDR).  The ACS's website on radiation for endometrial cancer  explains that:

There are 2 types of brachytherapy used for endometrial cancer, low-dose rate (LDR) and high-dose rate (HDR).

• In LDR brachytherapy, the applicator with the radiation source in it is left in for about 1 to 4 days. The patient needs to be still to keep the applicator from moving during treatment, so she's usually needs to stay in the hospital during treatment. Because the patient has to stay immobile, this form of brachytherapy carries a risk of serious blood clots in the legs (called deep venous thrombosis or DVT). LDR isn't commonly used in the US.
• In HDR brachytherapy, the radiation is stronger. Each treatment takes a very short time (usually less than an hour), and the radiation is only in for 10 to 20 minutes. The applicator is only in place when the treatment is done. You will be able to go home the same day. For endometrial cancer, HDR brachytherapy might be given weekly or even daily for at least 3 doses.

Here's the ACS link from which the above was taken:  https://www.cancer.org/cancer/endometrial-cancer/treating/radiation.html

woodstock99

Thanks everypne for all the

Thanks everypne for all the valuable info! Much appreciated. 

Lyn70

woodstock99 said:

Thanks everypne for all the

Thanks everypne for all the valuable info! Much appreciated. 

28 External RT followed by 3 Brachy placements

Hi, Woodstock99, 

I have stage IIIA endometrial adenocarcinoma with extensive LSVI. My radiation plan is 28 External Intensity Modulated Radiation Treatments followed by 3 HDR Brachy placements over a two week period. I am on day 7 of the 28 days today. The radiation oncologist suggested this plan to prevent reoccurence locally and then reoccurence in the vaginal cuff. 

Dak82

My brachy experience

I had all three of my brachytherapy treatments in about 12 days. After the first one, which took the longest due to fittings and dosage measures there literally 5-7 minutes. Took me longer to change my clothes. I was lucky that I had zero side effect and that part of my body, the origin of my cancer, has been clean of cancer indications. These treatments were done between my 2d and 3d chemo infusions (6 total). Before we discovered my lung metastasis I was going to have 25 external beam treatments--even got so far as getting the little tattoos. This total course of treatment was built at a tumor control panel/board where all the specialities get together to discuss options. Of course I was stage IIIC which made all the radiation options a no-brainer.

Best wishes on the way ahead!

Deb