Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you approach the adjuvant treatment for grade 1 endometrial cancer with micrometastasis in a sentinel lymph node if the tumor is otherwise low risk?
Micrometastates is considered N1(mi) and should be treated similarly to N1 disease. I would not observe a patient with micrometastatic nodal disease. Adjuvant therapy as per the institutional practice of chemotherapy +/- EBRT +/- brachytherapy.
In light of new NCCN guidelines that state combination chemotherapy + pelvic RT should be reserved for endometrial cancer of at least stage IIIB, will you recommend EBRT in addition to chemotherapy for stage IIIA endometrial cancers?
Well, this is a little hard.I think it is pretty clear that chemotherapy is really the foundation for treatment of advanced disease. PORTEC-3 looked at women with high risk stage I, stage II, or stage III, or tumors with serous or clear cell histology (very diverse group!) and noted a survival benef...
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...