Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Would you recommend adjuvant therapy for a 1A grade 2 endometrial adenocarcinoma with MELF pattern, and ITCs in one pelvic lymph node?
I would also favor a diagnostic CT scan. If both sides SNLN mapped, based on a favorable intrauterine factor, would favor brachy vs observation.
How would you sequence chemotherapy and radiotherapy for a patient with stage IIIC1 serous endometrial carcinoma?
Update to Recommendation (3/2025): Clinical trial data supports incorporating immunotherapy with chemotherapy in the adjuvant setting for this group of patients. My recommendation for a patient with Stage IIIC1 serous endometrial cancer depends on the HER2 status as follows: HER2+: Chemotherapy + t...
When can brachytherapy be used alone in the definitive treatment of FIGO IA1/IA2 medically inoperable cervical cancer?
Certainly, IA1 patients can be managed with brachytherapy alone, since the risk of LN metastases is very small. Of course, conization is another, simpler, option in selected cases. The use of brachy alone in IA2 patients is more controversial, and one can say that it would not be considered appropri...
In cervical cancer, is the presence of parametrial LNs with ITCs considered parametrial disease requiring adjuvant chemo +/- RT?
Depending on the patient's general condition and performance status, I would consider adjuvant treatment with chemoradiation. In this case, although there was a good pelvic lymph node dissection with 29 negative right and left pelvic nodes, there are positive parametrial nodes with ITC. One could co...
What is your approach to a cervical cancer in a patient with a previous supra-cervical hysterectomy?
I have had 2 patients with this scenario. Given that the primary site of disease remained intact, I chose to treat fundamentally the same as I would otherwise treat an intact cervix. Both were early-stage and underwent CRT with planned insertions intended to limit total treatment length to under 56 ...
What is your approach to first line systemic therapy in metastatic PD-L1 positive cervical cancer?
Without question, pembrolizumab should be included in first line systemic therapy and not reserved as a second line option. The transformative results from KEYNOTE-826 led to FDA approval on 10/13/21 of pembrolizumab in combination with platinum and taxane therapy (+ bevacizumab) for first line trea...
How do you manage a cT3bN0 endometrial cancer with large vaginal drop met s/p NAC and TAH/BSO with pCR?
I would offer EBRT plus brachytherapy. Also if distal vaginal mets, would add inguinal nodal region into the volume. If drop mets was not excised, would favor higher brachytherapy dose to the site of vaginal disease (EQ2 of 60 to 70 Gy).
What is your approach for treating locally-advanced gastric-type adenocarcinoma of the cervix?
We still treat with definitive chemo RT (cis) but if operable, then favor surgery first.
What do you view as the future role for the combination of durvalumab + olaparib + chemotherapy in the management of patients with advanced/recurrent endometrial cancer following the DUO-E trial results?
The results of DUO-E are very exciting and will serve a number of purposes. I was encouraged to continue to see that the combo of chemo IO performed better than chemo alone confirming the class effect that was seen in GY018 and RUBY. I wish there was a pre-planned comparison of the chemo/IO/Olaparib...
Would you recommend adjuvant chemo+IO +/- olaparib for patients with occult stage III disease identified after staging surgery with no measurable residual disease?
Although most of those patients were not included in the trial, it is definitely a discussion I would have for patients with MMRd tumors and would recommend it to them. I would for MMRd patients although they were not included in the trial if they had stage 3 endometrioid histology. More data on thi...