Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What do you view as the future role for the combination of durvalumab + olaparib + chemotherapy in the management of patients with advanced/recurrent endometrial cancer following the DUO-E trial results?
The results of DUO-E are very exciting and will serve a number of purposes. I was encouraged to continue to see that the combo of chemo IO performed better than chemo alone confirming the class effect that was seen in GY018 and RUBY. I wish there was a pre-planned comparison of the chemo/IO/Olaparib...
In a fit/young patient, how do you manage endometrial cancer with inguinal node involvement that has had favorable response after upfront systemic therapy?
If operable after chemo then surgery followed by adjuvant RT.
Would you recommend adjuvant chemo+IO +/- olaparib for patients with occult stage III disease identified after staging surgery with no measurable residual disease?
Although most of those patients were not included in the trial, it is definitely a discussion I would have for patients with MMRd tumors and would recommend it to them. I would for MMRd patients although they were not included in the trial if they had stage 3 endometrioid histology. More data on thi...
Do you give vaginal cuff brachytherapy and/or whole pelvis, for patients with Stage III endometrial adenocarcinoma?
Depends on the substage and extent of surgical staging: Stage IIIa serosa: I give pelvic RT alone often following chemotherapy. I would also add vag brachy in cases of cervical stromal invasion. Stage IIIa adnexae. Same as (1). Stage IIIb. I give pelvic RT plus vaginal brachy often following chemot...
How would you manage a cervical cancer patient with bulky PA LNs with direct extension and/or invasion into the lumbar vertebral bodies?
I would treat with definitive intent. May do chemo IO first and then definitive chemo RT.
What strategies have you found to be most helpful in improving patient compliance with vaginal dilator use after pelvic radiotherapy?
We attempted a randomized feasability trial to a study dilator use and test a theoretically driven enhanced educational program (EEP) to increase adherence, We did not find increased adherence to the EEP program. At present, other than good physician and nursing counselling, I am unaware of signific...
How do you best manage bulky, clinical stage IIA squamous cell cancer of the cervical stump in a patient with a previous partial supra-cervical hysterectomy?
This is not a common scenario in the clinic. It is an older type of surgery to do supracervical Hysterectomy. For stage IIA Sq. cell ca of Cx in the stump, I would start with chemoRT to pelvis to 45-50GY and then depending on the length of the stump if at least 2.5-3cm would offer intracavitary bra...
What factors do you use to determine whether to add brachytherapy to EBRT for IIIC endometrial cancer?
My philosophy is to use 45 Gy in 25 fractions of EBRT followed by two fractions HDR boost.
Is there any benefit to giving pelvic radiation prior to systemic chemotherapy or vice versa for a patient with stage IIIA uterine serous carcinoma?
At our institution we take the data from PORTEC III and generally apply it to all patients with Stage III disease given the improvement in OS and DFS. This was one of the largest inclusions of serous patients at 16% in either group, although still a relatively small number. With this in mind, I also...
Would you offer adjuvant therapy following successful resection of a solitary lung recurrence of leiomyosarcoma if no other evidence of recurrent disease on PET CT?
It is reasonable to observe this patient if no evidence of other disease and surgical margins were obtained, however, many would offer adjuvant chemotherapy or radiation to the bed of the resection. If the patient had a prior treatment at the initial diagnosis, another sarcoma chemotherapy regimen c...