Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How would you treat a p16+ squamous cell carcinoma confined in the recto-vaginal septum with no suspicious adenopathy on PET or MRI?
Early vaginal or anal cancer still has relatively high rates of lymph node involvement. In vaginal cancer, T1 lesions have lymph node involvement rates of 5 - 15%. In anal cancer, T1 lesions have a higher rate of 5 - 50%. If there are no mucosal changes then it is possible this is an in-transit LN f...
How would you deliver/time radiation for a patient with IIIC1 serous endometrial cancer who is HER2+?
Stage III (particularly IIIC) and serous histology are both risk factors for distant failure. In combination, the patient is at an even higher risk. Therefore, I would prioritize getting in all cycles of chemotherapy to maximize distant control; generally, this would comprise 6 cycles of carboplatin...
How would you manage a POLE mutated, p53 abnormal IA myoinvasive carcinosarcoma of the endometrium with no LVSI?
I would not change the management of IB and above non-endometrioid histology based on mutation analysis as almost all data is for endometrioid histology.
How do you approach boosting a vaginal cuff recurrence of cervical cancer with brachytherapy that is tethered to small bowel?
Tough case. Controlling cancer is important. MRI guided brachy and making sure GTV is adequately covered even if bowel wall gets that dose. Warn the patient about bowel obstruction and the need to bypass in future.
What factors impact your decision to include bevacizumab with primary chemotherapy for patients with BRCA+ or HRD+ ovarian cancer?
The decision for bev isn’t based on HRD or BRCA biomarkers – it is based on clinical factors and provider preference. Bev is approved for all epithelial ovarian cancer, advanced stage with and to follow platinum based chemotherapy based on a clinically and statistically significant improvement in PF...
Can non-16/18 HPV types cause ASCUS and squamous cervical metaplasia on biopsy within 3 months of acquisition, or would it take longer?
It isn't clear that HPV causes ASCUS. I'm not sure how to interpret "squamous metaplasia" as opposed to dysplasia, but certainly many HPV types other than 16 and 18 cause cervical dysplasia, and probably can do so within 3 months of acquisition. However, I would be cautious in telling a patient that...
In light of the improved outcomes seen in patients receiving IO +/- olaparib, what role, if any, do you think pelvic radiation still plays in the management of patients with advanced endometrial cancer?
The study included a wide spectrum of patients including advance stage with residual disease or recurrent with or without residual disease. Prior RT when indicated was allowed and about 40% had RT as part of care.
What is the maximum interval you would consider delivering adjuvant radiation therapy for endometrial cancer?
The data has not been evaluated prospectively but retrospective studies suggest RT delay beyond 8-9 weeks after surgery decreases efficacy of treatment. That being said, have treated high risk patients up until 16 weeks but explained the pros and cons of treatment.https://www.ncbi.nlm.nih.gov/pubmed...
In patients with recurrent endometrial carcinoma, how do you decide when to offer Carboplatin/Paclitaxel +/- pembrolizumab or dostarlimab (NRG-GY018/RUBY) versus Lenvatinib/Pembrolizumab (KEYNOTE-775)?
I take into account prior therapy regimen in the upfront setting, time to recurrence, burden of disease for pMMR recurrence, and of course, patient characteristics--can they tolerate chemotherapy (again) or how concerned I am about lenvatinib toxicity in said patient? If they have not had chemothera...
What dose and OAR constraints do you use for boost with IMRT or SBRT when a patient with cancer of the cervix is not a candidate for brachytherapy?
Concurrent chemoradiotherapy plus brachytherapy boost (intracavitary or interstitial) is the standard of care in patients with locally advanced cervical cancer. In light of published data suggesting inferior survival if brachytherapy is omitted from definitive treatment, we do not recommend utilizin...