Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
When would you add a vaginal cuff brachy boost to external beam radiation for uterine carcinosarcoma?
No prospective data but based on pelvic recurrence pattern suggesting cuff being commonest time, our approach 45 Gy in 25 fractions followed by 2 fractions HDR brachytherapy.
How do you treat a Stage I endometrial squamous cell carcinoma?
We have generally managed with same principal as endometriod histology
Would you recommend adjuvant therapy for a 1A grade 2 endometrial adenocarcinoma with MELF pattern, and ITCs in one pelvic lymph node?
I would also favor a diagnostic CT scan. If both sides SNLN mapped, based on a favorable intrauterine factor, would favor brachy vs observation.
How would you sequence chemotherapy and radiotherapy for a patient with stage IIIC1 serous endometrial carcinoma?
Update to Recommendation (3/2025): Clinical trial data supports incorporating immunotherapy with chemotherapy in the adjuvant setting for this group of patients. My recommendation for a patient with Stage IIIC1 serous endometrial cancer depends on the HER2 status as follows: HER2+: Chemotherapy + t...
In cervical cancer, is the presence of parametrial LNs with ITCs considered parametrial disease requiring adjuvant chemo +/- RT?
Depending on the patient's general condition and performance status, I would consider adjuvant treatment with chemoradiation. In this case, although there was a good pelvic lymph node dissection with 29 negative right and left pelvic nodes, there are positive parametrial nodes with ITC. One could co...
When can brachytherapy be used alone in the definitive treatment of FIGO IA1/IA2 medically inoperable cervical cancer?
Certainly, IA1 patients can be managed with brachytherapy alone, since the risk of LN metastases is very small. Of course, conization is another, simpler, option in selected cases. The use of brachy alone in IA2 patients is more controversial, and one can say that it would not be considered appropri...
What is your approach to a cervical cancer in a patient with a previous supra-cervical hysterectomy?
I have had 2 patients with this scenario. Given that the primary site of disease remained intact, I chose to treat fundamentally the same as I would otherwise treat an intact cervix. Both were early-stage and underwent CRT with planned insertions intended to limit total treatment length to under 56 ...
How do you manage a cT3bN0 endometrial cancer with large vaginal drop met s/p NAC and TAH/BSO with pCR?
I would offer EBRT plus brachytherapy. Also if distal vaginal mets, would add inguinal nodal region into the volume. If drop mets was not excised, would favor higher brachytherapy dose to the site of vaginal disease (EQ2 of 60 to 70 Gy).
What is your approach to first line systemic therapy in metastatic PD-L1 positive cervical cancer?
Without question, pembrolizumab should be included in first line systemic therapy and not reserved as a second line option. The transformative results from KEYNOTE-826 led to FDA approval on 10/13/21 of pembrolizumab in combination with platinum and taxane therapy (+ bevacizumab) for first line trea...
What is your approach for treating locally-advanced gastric-type adenocarcinoma of the cervix?
We still treat with definitive chemo RT (cis) but if operable, then favor surgery first.