78F with a history of morbid obesity, COPD, CHF, and current smoker with FIGO Stage IB (cT1b cN0 M0) G2 endometroid-type endometrial adenocarcinoma deemed to be too high risk for surgery as well as a brachytherapy procedure.
Rx: 4500cGy in 25 fractions followed by boost to 3000cGy in 6 fractions.
Sim/Planning:
Contours per Small IJROBP 2021.
Common iliac nodal CTV: 7mm uniform margin surrounding the right and left common iliac artery and vein excluding bone and muscle.
Presacral Nodal CTV: The presacral nodal CTV should be a relatively fixed strip of tissue measuring 1 to 1.5cm wide in a plane perpendicular to the face of the sacral bodies.
External iliac nodal CTV: Superiorly begins at the bifurcation of the CI vessels and should comprise a uniform 7mm margin placed around the vessels, not extending into bone or muscle and up to 10mm anteriorly.
Internal Iliac nodal CTV: Superiorly begins at the bifurcation of the CI vessels with a uniform radial margin of 7mm excluding bone and muscle.
Obturator nodal CTV: The strip of space about 15-18mm in diameter between the external and internal iliac nodal CTVs.
Regarding PTV expansions, the size of the expansion depends on multiple factors, including institutional standards.
No consensus guidelines available for SBRT boost for non-operable, non-brachytherapy candidate early stage endometrial cancer.
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