Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How would you approach treatment for a locally advanced cervical cancer in the context of a completely prolapsed uterus in a non-surgical candidate?
In the few cases I have done, it was reducible and would have it pushed in daily during the course of EBRT, and also made brachytherapy feasible. One which is not reducible is a challenge with both EBRT and brachytherapy. One can treat with chemo RT and hope regression of tumor would make brachyther...
How would you manage an elderly but otherwise healthy patient with a high grade endometrioid uterine cancer with micro metastasis to a SLN, but otherwise confined to the uterus with superficial myometrial invasion?
With sentinel lymph nodes, pathology can show isolated tumor cells, micro metastasis, or macro metastasis. Our tumor board definitely has debated on how to handle micro metastasis in any patient, but especially those that are elderly, have treatment limited by social determinants, or have to travel ...
What are your top takeaways from SGO 2022?
So many great presentations at SGO 2022! The depth of the science was amazing and the ability to co-mingle in person with new friends and colleagues was more than fabulous. Although I am asked to discuss 3 pivotal abstracts, I encourage all readers to review the many great presentations via the “OnD...
Would you include a seroma in an adjuvant radiation field for post-op endometrial cancer?
The general principle I follow is if I can include it safely, I would. Otherwise, would skip most of it (lymphocele). If lymphocele is the site of positive pathological node, then include it in CTV.
What brachytherapy regimen would you use for a patient who completed only the EBRT portion of their planned definitive chemoradiation course for locally advanced cervical cancer, who is now presenting with persistent/recurrent local disease?
I would favor exenteration. If not possible, then would favor chemo to downsize followed by brachy or brachy alone with total dose based on cumulative dose to rectum and bladder. At least aim for EQ2 of 40 Gy or above to HRCTV with hot spot in GTV to a higher dose.
What are your top takeaways in Gynecologic Cancers from ASCO 2023?
Gynecologic oncology research was strong at ASCO 2023. Results of the following 3 pivotal studies are practice changing. Marie Plante, MD: SHAPE trial: This non-inferiority CCTG (Canadian Cancer Trials Troup) trial enrolled 700 patients with low-risk squamous cell carcinoma, adenocarcinoma or adenos...
What lessons can we learn from RTOG 0418 in how to best use IMRT to treat endometrial cancer?
Despite an atlas and detailed instructions, there were still problems noted with contouring. I think the most important lesson is the need for careful contouring and the use of an ITV comprised of a fusion of full and empty bladder scans. I encourage people to place patient’s on RTOG 1203 – which ra...
Would you include a lymphocele in your IMRT treatment volumes for endometrial carcinoma?
We only include the lymphocele is there is a positive node in the area of the lymphocele. If the nodes are not positive in the area of the lymphocele - we do not include the entire lymphocele.
Once endometrial cancer recurs after no chemo or XRT, is it curative or palliative?
It depends on where the recurrence is. if it is a pelvic recurrence in the vagina or a nodal recurrence in the pelvis or PA region, then the goal of treatment is curative, although the salvage rate is much higher for vaginal recurrences than for nodal recurrences. The salvage rate is also a function...
How do you define and IR-CTV for cervical brachytherapy?
Since most outcome data based on HRCTV dose , I don't routinely contour or monitor dose to IRCTV for cervical cancerhttps://www.ncbi.nlm.nih.gov/pubmed/30605752