New Here-tough decision brachytherapy or full pelvic

Im so sorry you have to make such a hard desision.  Cancer desions are really hard.  Take the time you need to figure it out for your self.  I had to decide between bracytherapy and external radiation.  I decided on just bracytherapy  because i already had a diferent cancer over 20 years ago and had alot of radiation close to the same area.  My doctor didnt even want to do external radiation because i already had radiation close to there.  My stage was 2 and it was grade 3.  I was diagnosed with MMMT uterine cancer back in May of last year.  Some others  might have decided external radiation for my cancer but because i had cancer before I think that was my reason behind no external radiation. Good luck in your desision

These decisions don't seem to get any easier all along the way.  I don't have your exact cancer.  I am Grade 3a Stage 3 Endometrial Adenocarcinoma.  I had 6 rounds carbo/taxol and the gyn/onc wanted me to do brachytherapy as insurance on the cuff but the rad/onc wanted me to do 6 1/2 wks -daily full radiation.  It was very hard to decide and I went back and forth and read a lot on here and in the end decided that I did not want to do either.  Prayers are you consider your options and gather information.  (((HUGS)))

When I was wrestling with the same decision and freaking out about it last summer I learned which criteria mattered the most in tipping the scales either towards pelvic radiation or waiting for a possible recurrence before proceeding. The thread where I got a lot a great help here was titled "Still terrified" around August or September of 2016.

To put what I learned in a nutshell: You would benefit from pelvic radiation if your pathology results show one or more of the following: 50% or greater myometrial invasion, cancer originating in the lower uterine segment rather than higher up in the fundus (i.e. closer to or including the neck of the uterus and/or extending down towards the cervix; lymphovascular involvement; 

The way pelvic radiation is delivered really makes a big difference to how it impacts you. Some have RT prior to surgery or chemo, some have it sandwiched midway during chemo, and some, like me, have it after chemo. My doctor wanted it after chemo because he felt the radiation does some damage to pelvic blood vessels and that would impact delivery of the chemo drugs in the pelvis. There really doesn't seem to be much agreement out there on when it's the best time to have it. More important than the when, I think, is the how. I was offered 3D-CRT (3 dimensional-conformal RT) that shapes the delivery of radiation to avoid organs such as the bladder, urethra, colon, etc. to the extent possible to minimize long term side effects. Drinking a lot and taking a probiotic helps too. Diarrhea and/or constipation are an issue for most during treatment and potentially for a while after, but is generally easily managed.

I also had a "vaginal boost" after the pelvic RT which is basically the same as brachy, just delivered externally instead. You and I are pretty close as far as pathology, so it all depends on whether or not you'd sleep easier having done all you could do vs. taking a chance and waiting for a recurrence to have something to aim the radiation at. It's a tough decision with no guarantees no matter what you decide. 

CheeseQueen57 said:

3c Grade 3

And I had both external and internal as my doctors recommended. I had it after chemo. I too like LouAnn had insufficiency fracture of pelvis but doctors claim it was not due to radiation. My bones were not in good shape before this adventure. I've got some bladder issues but these should pass. I would do the radiation again for I feel it gave me best chance for survival. I have 6 month scan tomorrow. Fingers crossed. 

I'll be crossing my fingers, eyes, and toes for you! 

Cass, it doesn't sound to me like your gyn-onc and rad-onc have provided you with all the information you need in order to be able to make a fully informed treatment decision.  What are the reasons for each recommendation?  For example, I was treated for endometrial adenocarcinoma in 1999.  I had a deeply-invasive grade 2 tumor that had invaded approximately 80% of the myometrium.   The pathologist also found extensive lymph-vascular space invasion by my tumor, and it had also invaded the lower uterine segment.  These were all risk factors for recurrence.  Both my gyn-onc and rad-onc concluded that my treatment plan should include external radiation and brachytherapy.  It's been more than 17 years since I finished treatment and I have had no bone density or fracture issues. 

If I were you, I would ask your doctors to articulate the basis for their position on pelvic radiation as well as brachytherapy.  I might also seek additional opinions to help in making the decision.  I know some women take the position that they will hold off on radiation until they have a recurrence.  In some cases, they may be able to be effectively treated at recurrence, but it's my understanding that is not always the case.  That's why I think it's very important for you get all your questions answered before you decide how to proceed. 

Best of luck to you.

Cass83, I guess the good news is that once you decide on a treatment, you will likely still have the other treatment available to you if you need it in the future. Good luck to you and keep us updated on how you're doing. Kim

MoeKay said:

Need More Information

Cass, it doesn't sound to me like your gyn-onc and rad-onc have provided you with all the information you need in order to be able to make a fully informed treatment decision.  What are the reasons for each recommendation?  For example, I was treated for endometrial adenocarcinoma in 1999.  I had a deeply-invasive grade 2 tumor that had invaded approximately 80% of the myometrium.   The pathologist also found extensive lymph-vascular space invasion by my tumor, and it had also invaded the lower uterine segment.  These were all risk factors for recurrence.  Both my gyn-onc and rad-onc concluded that my treatment plan should include external radiation and brachytherapy.  It's been more than 17 years since I finished treatment and I have had no bone density or fracture issues. 

If I were you, I would ask your doctors to articulate the basis for their position on pelvic radiation as well as brachytherapy.  I might also seek additional opinions to help in making the decision.  I know some women take the position that they will hold off on radiation until they have a recurrence.  In some cases, they may be able to be effectively treated at recurrence, but it's my understanding that is not always the case.  That's why I think it's very important for you get all your questions answered before you decide how to proceed. 

Best of luck to you.

Maureen iterates of very good point in the last paragraph. It bears weighinh into the decision that treating recurrence is iffier than curing it the first time around. Cancer cells mutate and what worked before may not be an option for treating a recurrence. That's one of the reasons I decided to do all that I could rather than waiting for something to aim the radiation at. I really didn't want to, but now that it's behind me I have no regrets. 

I had 28 external treatments and 3 brachys. I was not really asked to make a choice because of the aggressive form of cancer I had and high number of positive lymph nodes (25). The external radiation seems to have done its job, since I was cancer-free at the end of treatment. So I'm glad I had the radiation even though that may be the cause of some of the side effects I'm having now, such as low blood and potassium levels. 

i had 28 external and 3 internal treatments. I took Culturelle probiotic and didn't have any diarrhea but for a few weeks after I took Immodium because of a little bowel urgency, but the Imodium solved the problem and I'm not bothered by it now (my treatment ended in October). I am having some bladder issues (burning, sloughing off of cells leading to more risk of infections) but working on resolving that now. They really don't think my fracture was related to the radiation but could have been related to the steroid use with chemo. You do have to regularly use the  vaginal dilator after radiation treatment which is kind of a hassle.  But all of this is worth it if it saves your life.  I'm still pretty deconditioned but I'm going to start physical therapy next week