Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
In what situations would you perform a sentinel lymph node biopsy for cervical cancer?
At my institution we currently consider doing sentinel lymph node dissections for all patients with FIGO stage IA2-IB2 (2018 staging system) who have normal appearing nodes on CT scan. Our protocol utilizes indocyanine green (ICG) tracer and the near infrared detection with ultrastaging. If one side...
Do you recommend adjuvant therapy for early stage (IB) high grade endometrial stromal sarcoma?
Tanner et al., PMID 22750260 demonstrated that these cancers have an exceptionally poor prognosis. Since there are no randomized trials, utilization of both adjuvant radiotherapy and chemotherapy with carboplatin/taxol or gemcitabine/taxotere would seem appropriate. As with endometrioid cancers of t...
What are your next steps in management for a patient with endocervical adenocarcinoma s/p radical trachelectomy with a positive pelvic lymph node noted on final pathology?
With any surgically resected cervical cancer (whether nodal assessment followed a traditional approach/radical hysterectomy or nodal assessment followed by a fertility sparing approach/radical trachelectomy), when there are positive nodes on final pathology, our tumor board recommends following Pete...
Would you recommend adjuvant therapy for a non-invasive Grade 3 endometrioid endometrial cancer that is P53 wild-type and MMR deficient (due to methylation)?
I would not give adjuvant therapy. The risk of nodal met is low based on GOG 33 and all other known data. Given that the tumor is p53 negative, I am going to assume it will not behave as a serous tumor.So, would observe.
What is your strategy for treatment of FIGO IIB cervical cancer in a patient who poorly tolerated the first insertion and refuses subsequent insertions?
Not other equivalent options. That being said, I would plan IMRT/IGRT boost with total dose to HRCTV (75-80 Gy) based on dose to rectum, bladder, and small bowel with tight PTV margin.
Would you consider maintenance therapy in a recurrent endometrial cancer that is MSI-H and ER/PR+ that achieved a complete response after pelvic RTx and 4 cycles of Carbo/Taxol?
Great question! Before answering, we must first answer the pivotal question: is there maintenance therapy that has been demonstrated to be beneficial for such a patient? (e.g. endometrial cancer patient after an excellent response to radiation and chemotherapy for recurrent disease)? If so, are thos...
How do you approach a patient with recurrent endometrial cancer within the field of prior primary radiation who is not a surgical or cytotoxic chemotherapy candidate?
There are several things to consider here.Assuming that there is truly no potential for surgery or cytotoxic chemotherapy then the remaining options are: targeted therapy, hormonal therapy, discussing with radiation oncology any role for additional radiation, or best supportive care.First, though, I...
Is adjuvant treatment recommend for a 0.8cm serous endometrial CA confined to polyp s/p hysterectomy + surgical staging?
For surgically staged IA confined to polyp, the risk of recurrence reported in literature varies but on average, appears to be low and recent ESGO guidelines favor no treatment.
What is the longest interval to proceed with brachytherapy boost for cervical CA after EBRT?
I would proceed with brachytherapy even after a delay of 2-3 months as that is still better than no brachy and if local recurrence occurs, then the patient would need exenteration. Another option to consider, if imaging and scan show great response to EBRT, it is the possibility of a hysterectomy. I...
Would you add olaparib to maintenance immunotherapy for a patient with recurrent MMR-proficient, HER2-negative serous endometrial carcinoma?
I think it is reasonable to treat HER2 non-amplified USC with anti-PD-1 in addition to chemotherapy as long as they are TP53 mutated (90-95%) of tumors. This was looked at in a survival sub-analysis in RUBY. Other considerations would be bevacizumab, as there is evidence this works in TP53 mutated t...