Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
In a surgically staged Stage II Grade 1 endometrial adenocarcinoma, with no other high risk factors, would you treat with brachytherapy alone or add on the pelvic RT?
Yes, the current stage II was excluded from PORTEC 1 and 2 and were part of GOG 99 and GOG 249. With stromal invasion there is risk of nodal, vaginal, and parametrial (if only simple hysterectomy was done) recurrence, and for that reason we offer pelvic EBRT. That being said, if stromal invasion is ...
For a patient with vaginal adhesions/stenosis, do you recommend any other therapy besides a dilator?
Yes! In patients who have received radiation and have stenosis I frequently given topical estrogen cream with their dilators to help prevent or treat vaginal stenosis. My patents report that it helps with the pain associated with vaginal atrophy when they try to use their dilator. I treat a lot of c...
Would uterine serosal involvement change your adjuvant treatment recommendation for a patient with Stage II grade 2 endometrial cancer?
Would recommend chemotherapy and vaginal brachytherapy. Had the patient had Stage II, Grade 2 disease (ignore the ITC for a moment), we would offer the patient pelvic radiation therapy alone based on GOG 249 and PORTEC 3 results, the latter of which showed a benefit of chemotherapy largely driven by...
How would you manage a clinically inoperable, stage IIIB, MMR deficient uterine cancer?
Tough situation and uncommon case. If definitely inoperable, your options are to do preoperative systemic therapy or preoperative radiation therapy. I often advocate for preoperative radiation therapy as these tumors tend to respond well to radiation, and you can save the standard-of-care chemothera...
How would you manage a Stage IB endometrioid endometrial cancer, status post staging surgery, with a rapid vaginal recurrence <1 month post operatively?
A rapid recurrence like this is unusual, but we have definitely seen it. Cuff recurrences require multidisciplinary management. The most worrisome feature of this patient is the rapidity of recurrence. For the initial management, I would probably have recommended some kind of adjuvant treatment afte...
How would you manage an elderly but otherwise healthy patient with a high grade endometrioid uterine cancer with micro metastasis to a SLN, but otherwise confined to the uterus with superficial myometrial invasion?
With sentinel lymph nodes, pathology can show isolated tumor cells, micro metastasis, or macro metastasis. Our tumor board definitely has debated on how to handle micro metastasis in any patient, but especially those that are elderly, have treatment limited by social determinants, or have to travel ...
How would you approach treatment for a locally advanced cervical cancer in the context of a completely prolapsed uterus in a non-surgical candidate?
In the few cases I have done, it was reducible and would have it pushed in daily during the course of EBRT, and also made brachytherapy feasible. One which is not reducible is a challenge with both EBRT and brachytherapy. One can treat with chemo RT and hope regression of tumor would make brachyther...
What chemotherapy regimen would you utilize for a metastatic, poorly differentiated carcinoma of the cervix with neuroendocrine features?
I would work with pathology to define if this is a true neuroendocrine cervical cancer versus a poorly differentiated cervical carcinoma with neuroendocrine features. This could potentially impact treatment decisions. I treat patients with poorly differentiated metastatic cervical carcinoma with the...
What are your top takeaways from SGO 2022?
So many great presentations at SGO 2022! The depth of the science was amazing and the ability to co-mingle in person with new friends and colleagues was more than fabulous. Although I am asked to discuss 3 pivotal abstracts, I encourage all readers to review the many great presentations via the “OnD...
What brachytherapy regimen would you use for a patient who completed only the EBRT portion of their planned definitive chemoradiation course for locally advanced cervical cancer, who is now presenting with persistent/recurrent local disease?
I would favor exenteration. If not possible, then would favor chemo to downsize followed by brachy or brachy alone with total dose based on cumulative dose to rectum and bladder. At least aim for EQ2 of 40 Gy or above to HRCTV with hot spot in GTV to a higher dose.