Radiation Oncology ECHO - Webinar-Case Presentation - Carcinoma cervix with nodal metastasis Management Challenges

Case Presentation - Carcinoma cervix with nodal metastasis Management Challenges

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A 58-year-old woman with no known comorbidities presented with bleeding and discharge per vaginum, as well as lower backache. Physical examination revealed a cauliflower-like growth replacing the cervix and involvement of the upper 1/3rd of the vagina and bilateral parametrium. Imaging confirmed the diagnosis of squamous cell carcinoma cervix with nodal metastasis. Following discussions in the Multidisciplinary Tumour Board Meeting, the patient received neoadjuvant chemotherapy with paclitaxel and carboplatin. A subsequent assessment showed a significant reduction in the size of the tumor and lymph nodes, with no evidence of distant metastasis.<br /><br />The patient then underwent radiation therapy planning, which included target definition and contouring of the primary tumor and nodal volumes, as well as identification of organs at risk. The treatment plan consisted of VMAT technique with different dose levels for various target volumes. Brachytherapy using a modified Fletcher Suite applicator and Iridium 192 as the radiation source was also performed.<br /><br />At the time of brachytherapy assessment, the patient showed minimal residual disease in the central area and minimal involvement of the right parametrium. MRI confirmed a significant reduction in the cervical mass. The patient completed treatment in September 2022 and is currently on follow-up.<br /><br />The total biological effective dose (BED) for the tumor, rectum, and bladder was calculated, taking into account both external beam radiation therapy (EBRT) and brachytherapy.<br /><br />In summary, this case involved a challenging management of carcinoma cervix with nodal metastasis. The patient received neoadjuvant chemotherapy followed by external beam radiation therapy and brachytherapy. The treatment resulted in a significant reduction in tumor size and lymph node involvement. The patient completed treatment and is currently being monitored for follow-up.

Keywords

carcinoma cervix

nodal metastasis

neoadjuvant chemotherapy

radiation therapy planning

VMAT technique

brachytherapy

biological effective dose

tumor size reduction

lymph node involvement

follow-up