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RO contouring
76 Cancer of the Uterine Cervix
- Cervical and Vaginal, Vulvar ca
- Cervical ca RO
- General Management
- EBRT : dose, fractionation, technique
- Brachytherapy
- Systemic therapy
- Recurrent
NCCN guideline : Cervical Cancer, 25v4
77 Endometrial Cancer
- For EECs, grade is based on the proportion of solid areas: low grade = grade 1 (≤5%) and grade 2 (6%–50%); and high grade = grade 3 (>50%)
- Low-grade EEC (endometrioid EM ca.) – NO ADJUVANT if ALL the below criteria are met.
- (1) no more than superficial myometrial invasion is present (<50%);
- (2) absence of extensive/substantial LVSI
- (3) absence of additional metastases
- (4) the ovarian tumor is unilateral, limited to the ovary, without capsule invasion/rupture (equivalent to pT1a).
- Serous ADC, clear cell ADC, mesonephric-like carcinomas, gastrointestinal-type mucinous endometrial carcinoma, undifferentiated carcinomas, and carcinosarcomas are considered high-grade by definition.
NCCN guideline : Uterine Neoplasms, 25v3
Prognostic risk groups of endometrial cancer patients according to the ESGO/ESTRO/ESP guidelines
2023 ASTRO guideline : detail
- Adjuvant RT: indication, techniques, target volumes, dose-fractionation regimen, and normal tissue constraints, decisions based on lymph node assessment
- Systemic therapy: indication, sequencing with RT
- Molecular marker influence on adjuvant RT and systemic therapy decisions
Uterine Sarcoma
- Uterine LMS: similar to EM ca. include pelvic LNs if RT naive
78 Ovarian and Fallopian Tube Cancer
NCCN guideline : Ovarian Cancer / Fallopian Tube Cancer / Primary Peritoneal Cancer, 25v3
79 Vaginal Cancer
NCCN guideline : Vaginal Cancer, 25v5
Management Summary
- Stage I (T1N0)
- Primary Surgery: if small (<2cm), R0 feasible, low morbidity
- Primary (C)RT: combination of cisplatin-CCRT+brachy is recommended.
- Locally Advanced (T2-4 or N1)
- Definitive platinum-based CCRT, consolidated by a brachytherapy boost
Systemic Therapy
- Cervical ca.에 준하여 cisplatin을 사용하나, 마찬가지로 pembrolizumab의 중요성이 대두
80 Female Urethral
81 Carcinoma of the Vulva
NCCN guideline : Vulvar Cancer, 25v1
Management
