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

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Concomitant weekly cisplatin is standard. However, weekly carboplatin or hyperthermia can be considered as an alternative option for patients not suitable for cisplatin. Fertility sparing procedures comprise of conization (see Figure 3), simple trachelectomy (see Figure 4), radical (vaginal) trachelectomy (see Figure 5), abdominal radical trachelectomy (see Figure 6) [III, B].

Future-proofing radiotherapy access. The fine balance between preferences and sustainability / Our resources are limited! An insight on optimising radiotherapy resources for the future / Speed Dating / Optimal health for all together - What do staff and patients need to achieve this? / The possibility to improve patient care is endless. (Some) initiatives to integrate into radiotherapy departments of the future / Young Networking Event & Quiz (including the Elsevier Young Investigator Awards Presentation)Estro Support is designed to help optimise the natural detoxification of estrogen and other hormone-like chemicals your body is exposed to, including plastics, soy products and even tap water.

In case of intraoperatively proven PLN involvement, fertility-sparing surgery should be abandoned and patients should be referred for CTRT and BT [IV, B]. PALND, at least up to inferior mesenteric artery, may be considered for staging purposes [IV, C]. Ovarian transposition cannot be recommended in N1 status [IV, D]. Conization and simple trachelectomy are adequate fertility sparing procedures in patients with T1a1 and T1a2 tumors, regardless of LVSI status [IV, B]. The management of “oligo” organ metastases (lung, liver, etc.) should be discussed in a multidisciplinary setting including the team involved in the treatment of the organ-affected metastasis. Treatment options are represented by local resection, thermal ablation, interventional BT, or stereotactic ablative radiotherapy according to the size and localization [IV, B].

HOW TO USE ESTRO SUPPORT?

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. Patients with recurrent/metastatic disease should have a full clinical-diagnostic evaluation to assess the extent of disease and the most appropriate treatment modality including best supportive care [V, A]. Patients should be carefully counseled on the suggested treatment plan and potential alternatives, including risks and benefits of all options [V, A]. In case of suspected tumor persistence, recurrence or second primary cancer, histological verification is strongly recommended [V, A]. In patients with cervical advanced cancer, a multidisciplinary approach of physicians, nurses, psychologists, social workers, and community health workers is needed to manage psychosocial and spiritual suffering associated with social stigma deriving from genital disease, malodorous vaginal discharge, etc [IV, A].

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