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Use of EXTERNAL BEAM RADIATION in STAGE-2b CERVICAL CANCER.

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My Mother was operated on 18th July for Cervical Cancer ( Wertheim's Hysterectomy). operation was successful and she is recovering fine. After the surgical Biopsy they declared it as Stage 2b, futher we sent her slides to SRL Ranbaxy for review and there they found the left paramatrium free & right paramatrium with few tumor cells all non reactive so Stage 1b. Now doctors here are saying there is one positive & one negative report so considering that she needs Radiation ( Both external Beam & Internal Beam ) + concurrent chemo apart from recent surgery to avoid the recurrence, I discussed this case with one more doctor & he do not think external beam radiation is indicated nor chemo at this time however brachytherapy to upper vagina could be given if surgeon was not able to remove all the tissue however closefollowup will be needed there is higher incidence of collateral damage with external beam radiation so try to avoid that include kidney damage. Please suggest. I am attaching her Reports.


Category: Oncologist

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Category: Hematologist
Dr. Prasad Eswaran is online now

Expert:  Dr. Prasad Eswaran replied 4 Days.

Thank you for your query at DoctorSpring.com.

Dear sir/madam,

I went through the reports and found that the parametrium seems to be involved. Though the FIGO staging system never mentions about isolated tumor cells presence, it decides the staging based on the parametrium involvement.

However, having undergone a definitive and a thorough surgery to remove the tumor, further radiation with chemotherapy and brachytherapy may be some kind of over treatment. However in my opinion, you cannot take a chance now of not treating.

A completion of treatment would be to go as above.

Alternate option is to go for chemotherapy alone with 6 cycles as a preventive measure reserving radiation for a later recurrence, if any.

The present case is a difficult scenario and opinions definitely vary. The ultimate decision is yours. Hoping and praying for your mother's complete recovery.

Please let me know if you have any further queries.
Regards.


Patient replied :

So in your opinion what should be the next usual treatment aprt from recent Surgery... Radiation Alone ( Internal + external) or Radiation with Concurrent Chemo.


Expert:  Dr. Prasad Eswaran replied 3 Days.

I prefer chemotherapy alone.
Reserve radiation for the future. Radiation after surgery is going to have a lot of complications.
This is my personal opinion on your difficult and not-so-common scenario.


Patient replied :

Thanks a lot for your Opinion but I have a final Question i.e.. can you please throw light as to what do this statement means in Ranbaxy Review report & what impact does this statement makes in totality......... " RIGHT PARAMETRIUM SHOW FEW TUMOR CELLS, HOWEVER NO REACTION IS SEEN AGAINST THESE TUMOR CELLS, THEREBY INTERPRETED AS FLOATER"


Expert:  Dr. Prasad Eswaran replied 2 Days.

Hello.
These may be few tumor cells which may have started to come out of the primary tumor through small blood vessel or a lymphatic channel. Sometimes there can be random cells present. This does not affect the managment protocol.
Please let me know if you have further queries.
Regards.


Dr. Prasad Eswaran
Category: Hematologist
Experience: 
Doctorate in Medicine (Fellowship in Oncology), DM,  Madras Medical College & Govt. General Hospital, Chennai, India.

Doctor of Medicine (Residency in Radiation Oncology) , MD, Christian Medical College, Vellore, Tamilnadu, India, 2004-06.

Diploma in Medical Radiology & Therapy (Residency in Radiation Oncology), D.M.R.T, Madras Medical College & Govt. General Hospital, Chennai, India, 2004-06.

Bachelor of Medicine & Bachelor of Surgery - M.B.B.S, Govt. Stanley Medical College & Hospital, Chennai, India, 1998-2004.
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