Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Would you recommend radiotherapy for a para-aortic recurrence of endometrial cancer in a patient who previous completed surgery, chemotherapy, and WPRT?
Yes, as a set of these patients are cured. I would treat pa chain with SIB to node along with concurrent cisplatinum to definitive dose
How do you plan for excess nonconforming vaginal tissue with a HDR cylinder?
CT based plan. You do end up seeing paravaginal tissue not covered by single channel cylinder. We have not chased that in adjuvant setting with outcome data showing low recurrence rate. Similar thoughts about small air gaps Richman et al., PMID 33384254.
How would you approach adjuvant therapy for a IIIC2, FIGO grade 2, endometrial cancer with 1/7 positive (para-aortic) lymph nodes?
Hopefully, that node removed at surgery. Would extend xrt fields to cover with chemo.
What is the best method for ensuring that vaginal cuff cylinder is in proper position at each fraction?
The best method depends on local context and what tech is available. For imaging, one can: re-CT each treatment, use fluoro (we have a C-arm), use the kV or MV imager on a Linac with an orthogonal pair or a CBCT. There are other methods also. Some practices don’t image verify (makes me nervous). For...
What is your adjuvant therapy for node positive, low grade endometrioid endometrial adenocarcinoma?
Chemotherapy (typically carboplatin/paclitaxel x 6 cycles), restage, and if no progression, whole-pelvic RT. Consider brachytherapy boost if cervical stromal or vaginal involvement and/or presence of other risk factors for vaginal cuff recurrence (e.g. LVSI, deep myometrial invasion, grade 3 [not in...
What is your approach to an incidental diagnosis of low risk endometrial cancer in a patient who underwent minimally invasive hysterectomy with uterine morcellation with gross intra-operative tumor spillage?
Little guidance is available in the literature on the optimal management of a patient with a low grade endometrial cancer who had a minimally invasive procedure with uterine morcellation and gross tumor spillage. Fortunately, this situation is not common. Wright et al. estimated the risk of occult m...
Do you follow GOG, ASTRO, or PORTEC recommendations for adjuvant therapy in stage I endometrial cancer patients?
I believe the current ASTRO guidelines encompass the older GOG and PORTEC guidelines for the most part and we follow these guidelines though we review all for the sake of completeness.For the first patient, barring other risk factors, I would offer adjuvant vaginal cuff brachytherapy; for the second...
How would you manage a bulky, locally advanced endometrial cancer with extensive parametrial involvement in a patient inoperable due to medical comorbidities?
PET CT staging. If suitable for definitive treatment, EBRT (concurrent chemo if able to get it) plus HDR brachytherapy.
When would you offer extra-fascial hysterectomy to patients with low-risk early-stage cervical cancer in light of data from the ConCerv trial?
Stage 1A1 and 2
Is there a role for chemotherapy and/or vaginal cuff boost to EBRT in FIGO IB1 cervical adenocarcinoma, status post total hysterectomy?
Recently presented SHAPE trial shows non-inferiority of simple hysterectomy to radical for IB1 disease or lower disease. So for the above patient, that may not change anything but certainly would need nodal assessment which could be from surgery or RT after PETCT.