Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
In what scenario would you give consolidation chemotherapy after chemoradiation for stage 3 cervical cancer with a good response?
The current standard for stage IIIB cervical cancer is primary external beam radiation + concurrent cisplatin based chemotherapy + brachytherapy (see NCCN guidelines CERV6). Clearly, given the failure rate with distant metastases after primary therapy, there exists significant interest in adjuvant c...
What is your process for obtaining and using next generation sequencing on patients with advanced endometrial cancer?
All patients initially have IHC done for MMR deficiency and then may go on to genetic testing, based on the results. Additionally, we send tumor to Foundation Medicine for sequencing which includes POLE mutations etc., and also for PDL1.
Are there instances where you prefer an SBRT boost rather than a brachytherapy boost when treating definitive locally advanced cervical cancer?
No.
What, if any, adjuvant treatment do you offer a a patient with stage I clear cell endometrial carcinoma?
Clear cell carcinoma is a rare tumor with sparse literature regarding its adjuvant treatment. There is a recent SGO review article on this topic that is a nice reference. For stage I uterine clear cell, there are no prospective studies to study the impact of adjuvant chemotherapy and/or radiation. H...
For a patient with recurrent endometrial cancer involving the vagina with a good response to EBRT (<5mm residual), how would you prescribe adjuvant brachytherapy with a cylinder to the entire vaginal length?
We focus on pre EBRT length, as recurrence patterns don’t support needing to treat the full length with 45Gy from EBrT sufficient, and series that have treated full length have shown higher toxicity.See discussion of this for summary of literature for volume of treatment.
What chemotherapy options are there for clear cell carcinoma of uterus with progression of disease on carboplatin and paclitaxel?
In the absence of prior radiation, localized disease may be radiated or surgically removed. For systemic disease, general recommendations for recurrent clear cell cancer of the endometrium are generally the same as for most histologies. The NCCN lists several regimens after failing front-line carbo/...
How would your follow-up change for a patient, non-surgical candidate, with endometrial cancer treated with definitive radiation?
I assume that the question refers to how follow-up would differ between a patient treated adjuvantly, i.e., following surgery, versus treated definitively, i.e., not a surgical candidate. I think there are quite a few variables here. Probably the most important consideration is the extent to which t...
Would you offer definitive RT to a patient with metastatic cervical adenocarcinoma s/p carbo/taxol/avastin with a partial response in the metastatic sites?
I have delivered definitive pelvic chemoradiotherapy to a handful of patients who had complete radiographic responses to neoadjuvant TCA. All patients remain disease-free several years later. As for a patient with only a partial response, I believe there is still a good argument to be made for the a...
Would you offer any adjuvant therapy for cervical cancer following total pelvic exenteration in the setting of a positive pelvic lymph node?
I am going to "eat a bit of crow" here and admit to having been schooled a bit by the esteemed Dr. @Dr. First Last. I admit to having immediately jumped to the post-rad hyst situation rather than post-exenteration, and I agree that the radicality of the operation could factor into the decision about...
When do you consider re-irradiating patients with recurrent cervical cancer?
Because I have been seeing and treating a reasonable number of these cases for 35 years, I have some strong opinions on the matter. Although external beam re-irradiation in the setting of recurrent cervical cancer is fraught with great hazards and poor outcomes, interstitial re-irradiation has a hig...