Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How would you treat a recurrent endometrial cancer at the vaginal cuff that was initially FIGO 1A with no adj treatment, in a patient with actively treated scleroderma?
I would favor brachytherapy alone using MRI based planning with either a multichannel or hybrid applicator. Dose 6 Gy x 6 to CTV and higher dose (hot spots) to GTV.
How do you manage a distal vaginal recurrence of endometrial adenocarcinoma in a patient who had adjuvant external beam and cylinder brachytherapy boost to the top 4 cm of the vaginal cuff?
I would treat with EBRT to primary plus both inguinal regions followed by image based brachytherapy. Would add concurrent chemo if bulky disease. Dose of EBRT adjusted based on overlapLing et al., PMID 30600093
How would you manage a patient in her 50s with FIGO IA clear cell carcinoma of the endometrium with extensive LVSI and ITCs in an obturator node after 6 cycles of carbo/taxol?
I would favor EBRT plus brachy boost.Here is a review and our treatment philosophy Musunuru et al., PMID 35248784
How would you treat an endometrial cancer with pelvic sidewall nodes, patient s/p TAH/BSO but nodes were fixed and unresectable?
We would treat with IMRT and IGRT with concurrent cisplatinum based chemotherapy, with SIB boost dose to involved nodes (dose based on size and proximity of critical organs) followed by adjuvant chemo.
What is the maximum time you would wait after hysterectomy to start RT for a FIGO II endometriod adenocarcinoma before cancelling treatment and saving for salvage?
Great question, and I don't know that there is a perfect answer. If I were going to answer with some specificity, I would say 4 months. Obviously this is not ideal. However, in the presence of more compelling indications for treatment (your question relates to stage II patients/stromal invasion), I ...
With COVID-19 worries, are you more likely to offer women with endometrial cancer vaginal cuff brachytherapy over EBRT?
I would treat with brachy alone, as even in a non COVID environment with her comorbidities, the benefit of EBRT is minimal in terms of survival.
Do you sample radiologically negative paraaortic nodes in cervical cancer patients with clinically positive pelvic nodes prior to initiating primary chemoradiation?
Possible options in PET-positive pelvic nodes and negative PA nodes: Treat at least the entire common iliac chain, including the aortic bifurcation nodal region, which is 1 level above the affected pelvic nodes. Treat the subrenal PA region prophylactically, especially if the common iliac region or ...
What adjuvant therapy do you recommend for comprehensively staged, stage II, FIGO grade 3 deeply invasive endometrial cancer?
I would strongly consider external beam therapy and adjuvant chemotherapy.
Would you consider robotic lymph node dissection and parametrectomy for a patient with incidental stage 1A2 cervical cancer after simple hysterectomy?
I would not consider a parametrectomy, but I would definitely do a lymph node evaluation. Depending on risk factors such as tumor size, presence of LVSI, and depth of invasion, I would start with a PET scan. Rates of positive lymph nodes can be as high as 8-10% for these early-stage cancers. If ther...
How does positive p53 staining influence your recommendation for adjuvant therapy in comprehensively staged early (stage IA or IB), grade 2, endometrioid endometrial cancers?
It does not influence my recommendations. If a study is available to potential study the risk conferred by P53, I would offer it to my patient.