Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
If metastatic disease is found at the time of minimally invasive hysterectomy for uterine cancer, when would you decide to convert to open versus minimally invasive debulking?
This depends on the extent of disease and your ability to debulk robotically. The goal should be a maximal cytoreductive effort. If that can be achieved minimally invasively, then use that approach. If not, then open.
What are real world exclusion criteria for the use of lenvatinib + pembrolizumab for advanced endometrial cancer?
Patients with active auto-immune disease or uncontrolled hypertension should give one pause.
What is your preferred adjuvant treatment for surgically staged IB dedifferentiated endometrial carcinoma, with negative SLNBx and extensive LVSI?
We would generally recommend chemotherapy at a minimum for a dedifferentiated uterine carcinoma, although approval of immunotherapy is unlikely to be obtained given IT was not studied in any stage I patients, even for high-risk histologies.As a radiation oncologist, for IB high-risk histologies case...
What is your treatment approach for an adenoma malignum of the cervix?
Data for this rare entity is mixed but for now, treat with the same philosophy as other histology with chemo RT.
In light of the SHAPE trial results, how would you manage a patient with an incidentally diagnosed FIGO IA1 cervical cancer after simple extrafascial hysterectomy/BSO?
Without question, I would recommend that this patient receive pelvic RT and probably cuff brachytherapy as well. The SHAPE trial (NCT01658930) enrolled "low risk" patients, but they allowed LVSI patients into the trial, even though this is a high risk feature for local recurrence. There were approxi...
Do you have cut off values for neutrophil and platelet counts when doing interstitial brachytherapy for cervical cancer?
For template-based interstitial brachytherapy, I (and my anesthesia colleagues placing the patient's epidural) require platelets > 100. I suppose for a hybrid one, could consider at 50-100 but I would still prefer > 100. > 50 is my personal threshold for ICBT alone. ANC thresholds - I'm generally ha...
How do you treat a locally advanced cervix cancer in a patient who declines brachytherapy?
You provide this lady with a curable disease the appropriate social support, mental health support, and transportation coordination in order for her to complete curative treatment with brachytherapy. Anything short of that in America with all our incredible resources and care options is substandard ...
What clinical and pathological factors guide your decision making when considering whether to recommend vaginal cuff brachytherapy following TAH/BSO for a FIGO stage IA or IB endometrial carcinoma?
The most important risk factors for vaginal wall recurrence for endometrioid adenocarcinomas are grade, depth of invasion and presence of lymphovascular invasion. Now that stage IA includes endometrium only and up to 50% myometrial invasion, it is important to consider the other risk factors. I usua...
What volumes would you use for salvage radiation in a patient with a pelvic lymph node recurrence of cervical cancer initially treated with surgery alone?
Assuming a PET is done, we treat one nodal region above the involvement (the entire common illiac nodes for pelvic only and paraaortic for common illiac involvement) along with vagina and paravgina with concurrent cisplatinum. The dose to involved node is 55 Gy in 25 fractions (equivalent to 58-60 G...
How would you treat a patient with a FIGO G1 pT1bN0 endometrial adenoCA involving the lower uterine segment with >50% invasion and a separate focus of disease found involving the endocervical mucosa with no cervical stromal invasion?
Brachy alone as mucosal involvement would not change my management.