Estro-Halt EU- Designed for Estrogen Support | Contains CDG, Indole-3-Carbinol & Apigenin

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There is limited evidence to guide the choice between surgical treatment vs CTRT with IGBT in LN negative patients with T1b3 and T2a2 tumors. Histology, tumor size, completeness of the cervical rim, uterine corpus invasion, magnitude of vaginal invasion, age, comorbidity, menopausal status, body mass index, hemoglobin and experience with type C radical hysterectomy are some of the factors to consider [IV, B]. Additional supplemental ma Teleworking is not just an option; it's a standard practice at ESTRO. As an employee, you may take control of your work-life balance by choosing if you want to work from home or from the office, with the added perk of a 4-day workweek under certain conditions.

For individuals who are pregnant, nursing, or managing known medical conditions, it is essential to seek guidance from a healthcare professional before use. Those with known allergies should exercise additional caution and conduct thorough research on the herbs' potential associations with allergies.

HOW TO USE ESTRO SUPPORT?

For surgery, avoidance of the combination of radical surgery and post-operative external radiotherapy requires acceptance for modifications of the traditional selection criteria (tumor size, degree of invasion, LVSI) for adjuvant treatment [IV, B]. Pathological macroscopic LN (GTV-N) should receive an EBRT boost. Simultaneous integrated boosting using coverage probability planning is recommended. Depending on nodal size and the expected dose contribution from BT a total dose of approximately 60 Gy EQD2 should be the aim of treatment. An alternative treatment option is surgical removal of enlarged nodes. Radical surgery by a gynecological oncologist is the preferred treatment modality. Laparotomy is the standard approach for all procedures which include radical parametrectomy [I, A]. Target contouring for EBRT should be based on 3D imaging (preferably fused MRI and PET-CT) performed in the supine treatment position. Controlled bladder filling is recommended to minimize uterus movements and to push the intestines away. The result of the gynecological examination (ie, clinical drawing and description) as well as diagnostic imaging should be available during the contouring phase. A contouring protocol including a margin strategy for handling of internal movement (ITV) should be used to minimize irradiation of organs at risk. The EMBRACE II protocol may serve as a template. The tumor related target volume for EBRT (CTV-T-LR) includes the primary cervical tumor (GTV-T), the uterus, parametria and upper vagina (or minimal 2 cm tumour-free margin below any vaginal infiltration respectively) and is optimally defined on MRI with assistance of the clinical findings.

If SLN is negative bilaterally in the pelvic level I area (below iliac bifurcation) LN dissection can be limited to level I [IV, B]. LN assessment should be performed as the first step of surgical management [IV, A]. Minimally invasive surgery is an acceptable approach for LN staging [IV, B]. Urinary derivation by ureteral stent or percutaneous nephrostomy should be considered to treat renal failure caused by tumoral obstruction. There are no clear guidelines to predict which patients will benefit from these procedures in terms of survival and quality of life, and its indication should be discussed carefully [IV, C]. Definitive management (ie, without tumor related surgery) consists of EBRT with concomitant platinum-based chemotherapy and BT. Delay of treatment and/or treatment interruptions have to be prevented to avoid tumor progression and accelerated repopulation. The overall treatment time including both EBRT and BT should therefore not exceed 7 weeks. Definitive CTRT and BT CTRT It is my great pleasure to invite you to ESTRO 2023 which will take place from 12 to 16 May in Vienna, Austria.

Footnotes

Patients with cervical cancer should be staged according to the TNM classification and the International Federation of Gynaecology and Obstetrics (FIGO) staging should also be documented [IV, A].

Para-aortic LN dissection, at least up to inferior mesenteric artery, may be considered for staging purposes in patients with positive pelvic nodes at imaging, or at frozen section [IV, C].

ESTRO 2023

Tumor involvement of suspicious nodes should be histologically confirmed because of its prognostic significance and the impact on the management up to 24 weeks of gestation (fetal viability) [IV, A]. Radical trachelectomy (type B) should be performed in patients with cervical cancer T1b1, LVSI-positive. In patients without deep stromal involvement and with a high probability of adequate endocervical tumor free margins, simple trachelectomy can be considered [III, B].