Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
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 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...
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 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.
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...
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.
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...
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...