Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
When do you offer observation for resected stage II endometrial cancer?
Fortunately, this is an uncommon situation. Even with stage II disease, there is no clear advantage to radical hysterectomy, and it subjects the patient to higher surgical morbidity, especially genitourinary. To my knowledge, data is sparse in terms of when it is appropriate to withhold any adjuvant...
Do you offer pelvic radiation for endometrial cancer with ITCs in the node(s) and no other high or intermediate risk factors?
This is an uncertain area with limited outcome data. Ultrastaging with SNLN is picking up more ITC of which the clinical significance is unclear and may result in overtreatment. The data suggests ITCs have much better outcomes then micro or macromets but possible inferior outcome to node negative di...
For stage IB1 cervical cancer s/p surgery with only 1 Sedlis criteria, should adjuvant pelvic EBRT or vaginal cuff brachytherapy be recommended in the presence of other adverse pathologic features, such as high tumor grade or very close but negative margins?
For patients with close margin would offer EBRT plus brachyhttps://www.ncbi.nlm.nih.gov/pubmed/16750323
How do you treat a Stage I endometrial squamous cell carcinoma?
We have generally managed with same principal as endometriod histology
Do you routinely check tumor genomics, including POLE status for new endometrial cancers?
This is an evolving question! My first comment is if it's not going to impact your treatment decisions, probably best not to order. But with increasing data to suggest the POLE mutated tumors may not require as intense therapy, it would certainly be reasonable to order - especially as a "tie-breaker...
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 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...
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.
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 ...