Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What strategies have you found to be most helpful in improving patient compliance with vaginal dilator use after pelvic radiotherapy?
We attempted a randomized feasability trial to a study dilator use and test a theoretically driven enhanced educational program (EEP) to increase adherence, We did not find increased adherence to the EEP program. At present, other than good physician and nursing counselling, I am unaware of signific...
Would the findings of a synchronous T1a ovarian endometrioid adenocarcinoma affect your treatment recommendation for a IB, G2 uterine endometrioid adenocarcinoma and LVSI?
These cases are always difficult to know if it is synchronous primary or metastatic disease and sometimes pathologist are able to clarify and other times not. Outcome is significantly better if they are synchronous primary as it appears to be the case here. If ovarian surgical staging is done, I wou...
Would you offer adjuvant therapy following successful resection of a solitary lung recurrence of leiomyosarcoma if no other evidence of recurrent disease on PET CT?
It is reasonable to observe this patient if no evidence of other disease and surgical margins were obtained, however, many would offer adjuvant chemotherapy or radiation to the bed of the resection. If the patient had a prior treatment at the initial diagnosis, another sarcoma chemotherapy regimen c...
Is there any benefit to giving pelvic radiation prior to systemic chemotherapy or vice versa for a patient with stage IIIA uterine serous carcinoma?
At our institution we take the data from PORTEC III and generally apply it to all patients with Stage III disease given the improvement in OS and DFS. This was one of the largest inclusions of serous patients at 16% in either group, although still a relatively small number. With this in mind, I also...
How would you approach radiation in a patient with IIIC2 SCC of the cervix with a history of ileoanal reanastomosis and j pouch?
Depends a bit on the specifics of the case (e.g. how big is the cervix?), but in general, I would limit the pelvic dose to around 40 Gy and push the brachytherapy dose a bit higher. For the brachytherapy, the use of image guidance potentially provides an opportunity for further limiting the dose to ...
Would you consider staging lymph node dissection for a patient referred for stage IA endometrial cancer and MELF pattern on final pathology?
Thank you for this interesting question. The implications of Microcystic, elongated, fragmented (MELF) pattern of myometrial invasion on clinical outcomes in patients with endometrial cancer remains unclear, with data abstracted from single or multi institutionalization retrospective studies. It doe...
What is your preferred surgical management of an endometrial cancer with clinically apparent extension to the cervix?
Given in this scenario with clinically apparent cervical extension and an MRI negative for parametrial involvement, I would want to also ensure the nodes appear normal making the disease consistent with FIGO stage II disease. In this scenario, if the patient does clinically have disease limited to t...
In which circumstances would you offer adjuvant brachytherapy to a surgically staged patient with endometrial cancer if they have received prior pelvic external beam radiation therapy for a non-gynecologic pelvic tumor?
Assuming that adjuvant treatment is clearly indicated based on pathology findings, I would likely offer it, with some caveats. Ideally, the previous RT would have been delivered on an adjuvant basis with a dose of 50 Gy or less to the vaginal cuff area. Rather than the typical 700 cGy x 3 fractions,...
When, if ever, would you perform Her2 testing in serous intraepithelial neoplasia of the endometrium?
It's not known whether HER2 expression or amplification is definitely prognostic for EIN, but I suspect it is and we know it is for stage I uterine serous carcinoma. Seeing HER2 expression in EIN makes me concerned about the possibility of a more aggressive disease. We're currently studying this at ...
Do you offer surgery for patients with early stage cervical cancer who you suspect will need adjuvant radiation regardless of surgical pathology results?
Very exophytic tumors in very young women can be treated nicely even if greater than 5 cm without radiation if pet negative and careful patient selection by pelvic exam in my experience.