Optimizing Radiation Therapy Delivery in Posthysterectomy Prolapse: A Technical Report.

Pelvic organ prolapse occurring shortly after hysterectomy is rare but may complicate adjuvant external beam radiation therapy (EBRT) in endometrial cancer. Delivering EBRT in the presence of prolapse may increase radiation exposure to adjacent organs and treatment-related toxicity, whereas surgical correction can delay adjuvant therapy. We describe a technically feasible, nonsurgical approach using a vaginal pessary to restore pelvic anatomy and facilitate EBRT planning. Pessary-assisted repositioning improved target delineation and reduced high-dose exposure to the bladder, vagina, and rectum without delaying treatment or causing toxicity. This Technical Report highlights a simple, patient-centered strategy to optimize radiation therapy delivery in complex posthysterectomy anatomy.