Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How would you approach an inoperable, elderly, frail patient with high risk endometrial cancer?
May be less toxic, unless patient is "inoperable" because of high anesthesia risks, making endometrial brachy risky.
How does the presence of microcystic elongated and fragmented (MELF) invasion impact post operative treatment of Stage IA FIGO grade 1 endometrial cancer?
MELF pattern may be associated with under-assessment of LVSI. In the setting of surgical assessment of nodes, we don’t change treatment recommendations just based on MELF pattern.
How do positive pelvic washings influence your decision to administer adjuvant therapy to early stage endometrial cancer who otherwise meets no criteria for adjuvant therapy?
<60y/o, grade 1 endometrioid endometrial cancer. TLH, BSO, sentinel nodes. Stage IA, focal LVSI, 20% myometrial invasion, negative sentinel nodes, positive pelvic washings. Positive pelvic washings are an adverse prognostic sign in patients with other high-risk features. This patient has low risk...
What is your fertility-sparing management of a stage IA1 cervical squamous cell carcinoma following a LEEP with negative margins and focal LVSI?
The data would suggest she has been adequately treated.
If metastatic disease is found at the time of minimally invasive hysterectomy for uterine cancer, when would you decide to convert to open versus minimally invasive debulking?
This depends on the extent of disease and your ability to debulk robotically. The goal should be a maximal cytoreductive effort. If that can be achieved minimally invasively, then use that approach. If not, then open.
What are real world exclusion criteria for the use of lenvatinib + pembrolizumab for advanced endometrial cancer?
Poorly controlled Hypertension Active flare of autoimmune disease On immunosuppressant therapies
What is your preferred adjuvant treatment for surgically staged IB dedifferentiated endometrial carcinoma, with negative SLNBx and extensive LVSI?
We would generally recommend chemotherapy at a minimum for a dedifferentiated uterine carcinoma, although approval of immunotherapy is unlikely to be obtained given IT was not studied in any stage I patients, even for high-risk histologies.As a radiation oncologist, for IB high-risk histologies case...
What is your treatment approach for an adenoma malignum of the cervix?
Data for this rare entity is mixed but for now, treat with the same philosophy as other histology with chemo RT.
Do you have cut off values for neutrophil and platelet counts when doing interstitial brachytherapy for cervical cancer?
For template-based interstitial brachytherapy, I (and my anesthesia colleagues placing the patient's epidural) require platelets > 100. I suppose for a hybrid one, could consider at 50-100 but I would still prefer > 100. > 50 is my personal threshold for ICBT alone. ANC thresholds - I'm generally ha...
How do you treat a locally advanced cervix cancer in a patient who declines brachytherapy?
You provide this lady with a curable disease the appropriate social support, mental health support, and transportation coordination in order for her to complete curative treatment with brachytherapy. Anything short of that in America with all our incredible resources and care options is substandard ...