Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Would you treat endometrioid adenocarcinoma arising from an endometriosis lesion in a patient with prior hyst/BSO like an ovarian or endometrial primary?
For a patient with prior hyst/BSO and now an endometriosis-associated endometrioid adenocarcinoma, I would start by getting next-generation sequencing and MSI/MMR testing of the tissue specimen that was used to make the diagnosis. This would allow for additional information and the potential use of ...
How do you approach small bowel constraints in the setting of reirradiation?
This is a very tough question to answer. I agree with Dr. @Dr. First Last's answer.The maximum dose for the small bowel during reirradiation can vary depending on various factors such as the previous dose received, the interval between radiation treatments, the purpose of reirradiation (palliative o...
What uterine risk factors do you consider when recommending VBT boost after EBRT?
Since most patients who need EBRT now have high risk disease with more than one adverse factor, we prefer EBRT 45 Gy in 25 followed by 5 Gy x 2 for almost all unless the patient declines brachytherapy.
What post-treatment surveillance strategy do you employ for patients who undergo conservative fertility-sparing surgery for early-stage cervical cancer?
For patients undergoing fertility-sparing surgery for early-stage cervical cancer not dissimilarly to any other patient treated for early-stage cervical cancer. I would recommend that the patient undergo a history and exam, including a pelvic exam, every 3 months for the first 2 years, then every 6 ...
What does bevacizumab contribute in metastatic cervical cancer when used in combination with a platinum doublet + pembrolizumab?
I'm not sure how to answer the question. GOG 240 established paclitaxel/carboplatin/bevacizumab as the standard for first-line therapy for metastatic or recurrent cervical cancer.The BEATcc trial was a subsequent phase III trial for stage IVB, recurrent or metastatic cervical cancer that randomized ...
How do you manage early stage uterine carcinosarcoma?
Unfortunately, no good prospective study has shown an impact on survival with any adjuvant treatment. Based on relapse patterns at our institution for surgically staged IA disease, it is chemotherapy (ifosfamide plus taxol) plus cuff brachy. For all other stages, it is usually chemo as above followe...
Would you offer adjuvant radiation in addition to chemotherapy for a patient with stage IIIC uterine carcinosarcoma with cervical involvement?
This is a hard situation as there is no clear data for the exact treatment plan. For surgically staged patients with stage IIIC uterine cancer our tumor board treatment plans typically include discussion of PORTEC-3 (de Boer et al., PMID 31345626) and GOG-258 (Matei et al., PMID 31189035). Patients ...
What are your top takeaways in Gyn Cancers from ASCO 2025?
We had some exciting abstracts for ASCO 2025! These gynecologic oncology abstracts highlight some truly impactful advancements. Here's a concise breakdown of the key findings and their potential implications: 1. CALLA Trial – ctDNA Detection in LACC (Abstract #5502, Dr. Mayadev et al.)Study Focus: E...
Do you offer ovarian transposition to premenopausal cervical cancer patients prior to chemoradiation therapy?
Ovarian transposition or oophoropexy is definitely something to consider in premenopausal patients prior to chemoradiation for cervical cancer. Ovarian function is sensitive to radiation with as little as 2Gy leading to permanent ovarian insufficiency via follicular loss, limiting follicular maturat...
What is your approach to the adjuvant treatment of early-stage mixed-histology endometrial cancer with a significant clear-cell component?
Clear cell carcinomas are under-represented in most clinical trials and hence, clear evidence-based recommendations are difficult to make. Even a small percentage of clear cell is sufficient to label these as “high grade”. The recently published ASTRO guidelines mention that chemotherapy may not ben...