Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
When do you include the mesorectum for definitive cervical cancer patients getting concurrent chemoradiation followed by brachy?
I would also include it if there is direction invasion into the mesorectum or EMVI.
Would you consider giving vaginal estrogen to a patient with a history of low grade, early-stage endometrial cancer who has had a vaginal cuff recurrence (treated with radiation)?
Yes, I would consider this... after a discussion with the patient regarding the pros and cons. Ultimately, it would be her decision. The risks would also be dependent on the time of recurrence and the institution of the vaginal estrogen. Systemic absorption should be small. The biggest risk would be...
What treatment would you recommend for a healthy patient with an 8 cm central pelvic recurrence of leiomyosarcoma not involving any vital structures, associated with an FDG-avid 1 cm external iliac LN?
Assuming in good health, I would consider an attempt at resection. Worst case, you can’t, and you aren’t any worse off. I have debulked these before and found them often to be surprisingly resectable without high morbidity. Then I would make sure to test for ER/PR, and if positive, follow that with ...
Do you perform routine cystoscopy after hysterectomy for gynecologic cancer staging?
No. Compared to no cystoscopy, there is no change in change in rate of delayed urinary injury -which, when performing cystoscopy routinely, is ostensibly what you are trying to avoid.
For a patient with IIIC1 (micromets), MSI-high, Grade 2 endometrial adenocarcinoma who has undergone full surgical staging, do you recommend adding immunotherapy to adjuvant chemotherapy + radiation?
Short answer: No, I do not recommend adjuvant CT/IO + RT for this patient based on the patient's risk factors in the prompt, and the data below. Should the patient have recurrent/metastatic disease following adjuvant CT + RT/VCBT, then I/O + CT is a good option. Ongoing trials hope to answer this qu...
What would be your radiation boost technique and dose levels for adjuvant treatment of endometrial cancer with high-grade disease or aggressive histology if there was a positive margin at the parametrium after TAH+BSO?
I usually consider 50.4 Gy with EBRT followed by an additional 5.4 Gy to the parametrial region. Whether this additional boost helps is not known.
Would you include a seroma in an adjuvant radiation field for post-op endometrial cancer?
The general principle I follow is if I can include it safely, I would. Otherwise, would skip most of it (lymphocele). If lymphocele is the site of positive pathological node, then include it in CTV.
Is it necessary to include entire lymphocele in CTV while treating post operative nodal sites of pelvic malignancy?
I don’t know if necessary or not but I tend to include it if can do it safely. If large and pathological node was negative, then skip to reduce dose to OAR.
Do you sample radiologically negative paraaortic nodes in cervical cancer patients with clinically positive pelvic nodes prior to initiating primary chemoradiation?
Possible options in PET-positive pelvic nodes and negative PA nodes: Treat at least the entire common iliac chain, including the aortic bifurcation nodal region, which is 1 level above the affected pelvic nodes. Treat the subrenal PA region prophylactically, especially if the common iliac region or ...
How often do you believe para-aortic radiotherapy in addition to pelvic radiotherapy causes additional treatment breaks due to acute toxicity?
I would agree with @Dr. First Last that with IMRT and accurate definition of targets and organs at risk, that treatment can be delivered successfully. In patients who have had prior chemotherapy, attention to weekly blood counts is imperative. It is usually the platelet counts that pose a challenge....