Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you boost a positive parametrial margin in endometrial cancer after TAH BSO?
For a patient with a positive margin, we would first want to image post-operatively to make sure there isn't any gross disease. MRI is most helpful for this. The goal for the dose would be to treat this region to about 60 Gy. We would initially treat the pelvis to 45 Gy with an integrated boost at t...
Do you add trastuzumab to adjuvant chemotherapy for patients with Her2+ stage I-II high grade serous uterine cancer following surgical staging?
No, I don’t routinely add trastuzumab to adjuvant chemotherapy for early stage Her2+ serous endometrial cancer patients. There are no data supporting its use in this manner. My recommendation is to offer her treatment on GY026, a study enrolling both early and late-stage serous endometrial cancer pa...
How would you manage a young, healthy patient s/p open radical hysterectomy/bilateral salpingectomy/ovarian transposition/bilateral SLND with now stage IB3 HPV-dependent adenosquamous cervical carcinoma?
Adjuvant chemo/RT
What adjuvant therapy do you recommend for early stage poorly differentiated small cell neuroendocrine carcinoma of the cervix after surgical resection?
As Dr. @Dr. First Last has so eloquently explained, this is a rare and aggressive tumor. Often, what we think is early stage is not early stage at all. I would recommend CT or MRI brain imaging as well as a PET/CT. if there are no distant metastases, then I would offer at least 4, and up to 6 cycles...
How do you manage steroid-refractory immune checkpoint inhibitor induced pneumonitis?
Steroid-refractory immune checkpoint inhibitor (ICI)-induced pneumonitis is managed with high-dose steroids plus an additional immunosuppressive agent, like infliximab or intravenous immunoglobulin (IVIG) among others. I recommend early immunomodulatory escalation as multiple studies have shown that...
What are your top takeaways from SGO 2025?
Results from the NRG Oncology GOG-0263 phase III clinical trial testing the addition of cisplatin-based chemotherapy to adjuvant radiotherapy following radical hysterectomy for patients with early-stage, intermediate-risk cervical carcinoma indicated that the addition of chemotherapy did not improve...
Does the presence of a POLE mutation in endometrial cancer guide your recommendations regarding adjuvant radiation?
It’s part of PORTEC 4 study to randomize patients to adjuvant RT based on molecular subtype. They are exploring if observation is suitable option for POLE type Outside of a trial we still decide based on stage and grade for adjuvant treatment and not on molecular subtype.
Would you treat with extended field pelvic radiation for a patient with FIGO IIIC1 endometrial cancer who was found with isolated tumor cells (ITCs) on a single paraaortic sentinel lymph node?
I would favor pelvic and PA nodal RT as it has an increased risk of additional disease in the PA region with a combination of pelvic node-positive and ITC in PA node.
In patients treated with the KEYNOTE A-18 regimen who later recur, would you rechallenge with immunotherapy again?
Limited data in this clinical scenario. Per A18 (Lorusso et al., PMID 38521086), 32 patients received ICI as post-progression therapy, 25 of whom received Pembro. I am unable to find in the supplements whether those were patients from the placebo arm or from the pembro arm.I think if the patient rec...
If a patient with locally advanced cervical cancer cannot receive brachytherapy following 45Gy to the whole pelvis, how do you optimally deliver your boost?
One should be very cautious, as in our experience the situation where you can't do brachytherapy is very rare. There is a trend in the country to use a non-brachytherapy boost as it is more accessible but this approach can lead to worse outcomes. See Dr Viswanathan's paper recently published in the ...