Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
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...
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...
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.
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
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...
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?
I would favor repeat surgery if that is an option as otherwise salvage rate very low. If it can't be done, then assess for interstitial brachy.
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 ...
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...
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...
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...