Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Do you have any normal tissue constraints for endometrial cancer patients receiving EBRT and vaginal cuff brachytherapy?
We use following constraints for EBRT35 Gy to less than 35% of bowel bagRectum 40 Gy less tha 40-60% Bladder 40 Gy less than 40-60%Bone marrow ( pelvic bone) V20 less than 75% Femoral heads V35 less than 5%for brachy as adjuvant we give 5 Gy x2 to thickness of vaginaSince total dose loss limit and p...
What approach have you found works best in treating persistent acute radiation proctitis in patients undergoing pelvic EBRT?
Obviously, this is an important question, though I'm a little unclear on the meaning of "persistent acute" radiation proctitis. Though I am not certain, I believe @Dr. First Last's answer applies more to chronic (or at least sub-acute) radiation proctitis. As for the more traditionally "acute" radia...
How do you approach boosting a vaginal cuff recurrence of cervical cancer with brachytherapy that is tethered to small bowel?
Tough case. Controlling cancer is important. MRI guided brachy and making sure GTV is adequately covered even if bowel wall gets that dose. Warn the patient about bowel obstruction and the need to bypass in future.
What factors impact your decision to include bevacizumab with primary chemotherapy for patients with BRCA+ or HRD+ ovarian cancer?
The decision for bev isn’t based on HRD or BRCA biomarkers – it is based on clinical factors and provider preference. Bev is approved for all epithelial ovarian cancer, advanced stage with and to follow platinum based chemotherapy based on a clinically and statistically significant improvement in PF...
Can non-16/18 HPV types cause ASCUS and squamous cervical metaplasia on biopsy within 3 months of acquisition, or would it take longer?
It isn't clear that HPV causes ASCUS. I'm not sure how to interpret "squamous metaplasia" as opposed to dysplasia, but certainly many HPV types other than 16 and 18 cause cervical dysplasia, and probably can do so within 3 months of acquisition. However, I would be cautious in telling a patient that...
In light of the improved outcomes seen in patients receiving IO +/- olaparib, what role, if any, do you think pelvic radiation still plays in the management of patients with advanced endometrial cancer?
The study included a wide spectrum of patients including advance stage with residual disease or recurrent with or without residual disease. Prior RT when indicated was allowed and about 40% had RT as part of care.
How have you incorporated mirvetuximab into the treatment of platinum-resistant ovarian cancer?
This question is going to be increasingly important in the current landscape of ovarian cancer management. I have prioritized early ordering of biomarker testing so that I have the test profiles available at recurrence, particularly in the platinum-resistant standpoint.I find that toxicity, patient ...
What is the maximum interval you would consider delivering adjuvant radiation therapy for endometrial cancer?
The data has not been evaluated prospectively but retrospective studies suggest RT delay beyond 8-9 weeks after surgery decreases efficacy of treatment. That being said, have treated high risk patients up until 16 weeks but explained the pros and cons of treatment.https://www.ncbi.nlm.nih.gov/pubmed...
In patients with recurrent endometrial carcinoma, how do you decide when to offer Carboplatin/Paclitaxel +/- pembrolizumab or dostarlimab (NRG-GY018/RUBY) versus Lenvatinib/Pembrolizumab (KEYNOTE-775)?
I take into account prior therapy regimen in the upfront setting, time to recurrence, burden of disease for pMMR recurrence, and of course, patient characteristics--can they tolerate chemotherapy (again) or how concerned I am about lenvatinib toxicity in said patient? If they have not had chemothera...
What dose and OAR constraints do you use for boost with IMRT or SBRT when a patient with cancer of the cervix is not a candidate for brachytherapy?
Concurrent chemoradiotherapy plus brachytherapy boost (intracavitary or interstitial) is the standard of care in patients with locally advanced cervical cancer. In light of published data suggesting inferior survival if brachytherapy is omitted from definitive treatment, we do not recommend utilizin...