Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Would you add a brachytheray boost to a locally advanced cervical cancer after surgical resection and pelvic RT?
In general, a brachytherapy boost following external radiation is not standard when treating women for locally advanced cervical cancer post hysterectomy. Neither of the 2 major adjuvant GOG trials (92 and 109) allowed a brachytherapy boost, and even the currently open GOG trial, GOG 263, does not i...
Would you recommend surgery or stereotactic radiation therapy for a young woman with high-grade serous ovarian cancer presenting with a pelvic LN oligometastasis following maintenance therapy?
Like OM, the principle for other cancer favors SBRT as has excellent local control and low morbidity Donovan et al., PMID 38869888
Do you recommend Hyaluronic Acid Therapy for vaginal dryness in female patients post pelvic RT?
I do not. Not saying you shouldn’t though. I recommend coconut oil which can be used with a vaginal dilator, for intercourse or purely for hydration. If ineffective, I will refer back to gynecology. There may be a role for topical estrogen depending on the cancer histology.
What is the optimal adjuvant vaginal brachytherapy schedule when a patient is getting concurrent chemotherapy?
I treat in the two weeks between cycles once adequately healed from surgery. Often this is between cycles 1-2 but occasionally between 2-3. I don’t modify my prescription.
How would you approach treatment for a primary carcinosarcoma of the cervix with pelvic and para-aortic nodal involvement?
There is limited information on this situation. A series from Washington University (Gynecol Oncol 2005; 99: 348) demonstrates that curative intent treatment can be rewarded with long term survivals if disease is confined to the pelvis. Curative treatment could include chemo-RT, radical surgery, or ...
Would you offer adjuvant RT to a FIGO IV endometrial CA with pulm mets s/p hysterectomy with residual disease, then cCR to both sites after chemotherapy?
For stage IVB with extra pelvic mets to lung or liver, I have not offered adjuvant RT as the high risk of other mets would negate any benefit of adjuvant RT. If they develop isolated local relapse, then would consider for salvage.
How do you address extended break from EBRT during cervical cancer treatment?
EMBRACE data suggest HRCTV dose needs to be increased by 5 Gy for each week delay beyond 50 days to counter the downside of delay. We try to do that using hybrid applicator but total dose is still limited by OAR dose and we try to push as much as we can. (HRCTV to 90-95 Gy)
What would you recommend in the adjuvant settings for an elderly patient status post hysterectomy without nodal staging and was found with FIGO 1A, G3 endometrial cancer, with no LVSI and no myometrial involvement, without nodal staging?
Imaging for staging. Brachytherapy alone as adjuvant treatment.
Do you offer patients with advanced endometrial cancer lower starting doses of lenvatinib when used in combination with pembrolizumab given high adverse event rates with 20 mg daily?
For the first part of the question, "Do you offer patients with advanced endometrial cancer lower starting doses of lenvatinib when used in combination with pembrolizumab given high adverse event rates with 20 mg daily?" The strategy of administering lenvatinib therapy by starting at the established...
Is there a difference in the incidence of serious immune-related adverse events with the lenvatinib + pembrolizumab combination vs pembrolizumab alone in endometrial cancer?
Yes, high risk of both hypertension and diarrhea. The diarrhea can be very difficult to manage. The lenvatinib definitely adds a level of complexity to the management of pembro side effects. This requires dose reductions and interruptions, maybe even hospitalization for dehydration/renal insufficien...