Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Would you give additional radiation for a positive margin after salvage hysterectomy for a patient with cervical cancer who had initial definitive chemoradiation with EBRT+T&R?
Patients usually have radical hysterectomy, so repeating surgery is not an option for most cases. I may recommend vaginal cuff brachytherapy in this case.
How successful is IVF after definitive radiation therapy to the pelvis for endometrial cancer?
The most extensive data regarding the effects of uterine RT are for pre and peri-menarchal girls. Although women who had pelvic RT as children can often become pregnant if the ovaries are still functional, even doses as low as 10-20 Gy cause atrophic development of the uterus with decreased uterine ...
How do you counsel patients with BRCA-1 mutations regarding the role of hysterectomy as a part of risk-reducing surgery?
I routinely offer hysterectomy at the time of risk reducing BSO for BRCA1 mutations. There is an approximate ~3% risk of serous uterine cancers in these patients (Uterine Cancer After Risk-Reducing Salpingo-oophorectomy Without Hysterectomy in Women With BRCA Mutations). Additionally, in patients wh...
What adjuvant therapy would you offer a patient with Stage II uterine serous carcinoma without lymph node sampling?
Since the major concern for UPSC is distant mets, these patients typically first receive 6 cycles of carboplatin/taxol after surgery at our institution. If the patient tolerates it without significant toxicity and re-staging scans are clear, we would then offer whole pelvis RT (45 Gy in 25 fractions...
Would development of a rectovaginal fistula mid-treatment with second line pembrolizumab/lenvatinib for endometrial cancer cause you to change regimens, eliminate lenvatinib, or continue current therapy?
These complications are always difficult situations. Given she is having a response to therapy and her disease is not curable, I would have a discussion with her about the option of diversion with a colostomy after imaging and discuss holding therapy perioperatively but would consider restarting aft...
How would you treat/counsel a patient with Stage IB3 SCC of the cervix who is 18 weeks pregnant and desires to maintain pregnancy?
Difficult situation. The patient should be offered termination of pregnancy. If that is not the patient's choice, or if it is not a possibility, then I would suggest surgical lymphadenectomy as a first step. If nodes are negative, one can consider neoadjuvant chemotherapy with platinum based chemot...
How do you approach systemic treatment for endometrial endometrioid adenocarcinoma with neuroendocrine differentiation?
We treat these as endometrioid primary as the histologic diagnosis states, "endometrioid endometrial adenocarcinoma with neuroendocrine differentiation" instead of "primary neuroendocrine carcinoma of the uterus." Therefore, follow the literature from GOG 209 to support carboplatin/paclitaxel, espec...
For patients with endometrial recurrence of vaginal vault/pelvis, who are not candidates for brachytherapy boost, what external beam boost dose have you used following pelvic EBRT?
It’s unusual not to be able to do brachytherapy but sometimes for side wall/parametria recurrences that are not accessible, can deliver 66-70 Gy based on OAR tolerance.
What is the optimal approach for a younger female with borderline resectable cervix cancer who may need adjuvant radiation, in light of a medical history significant for ulcerative colitis?
It all depends on the colitis status on therapy including the extent and response to ongoing treatment. No induction chemo. Either radical hysterectomy with the possibility of adjuvant RT or definitive RT based on colitis status. If high risk with RT, would proceed with surgery.
After presentation of the SHAPE trial at ASCO, would you consider offering a simple hysterectomy with pelvic LN dissection for early stage cervical cancer <2cm?
Absolutely. This is the first study to actually ask this question. There has never been data showing radical hyst improves survival in early stage cervix ca. This study shows that early stage cervix ca can be treated less aggressively than previously thought. That being said, they should still see a...