Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
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.
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...
Are there instances where you prefer an SBRT boost rather than a brachytherapy boost when treating definitive locally advanced cervical cancer?
No.
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/...
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.
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...
Would you modify standard WPRT+brachy radiation for cervical SCC s/p negative nodal staging but aborted hysterectomy due to previously undetected superficial vaginal disease?
Would treat same with EBRT to 45 Gy in 25 fractions. (Pelvis) With concurrent chemo and brachy.
Are there any data that suggest superiority of lenvatinib + pembrolizumab vs platinum-based cytotoxic chemotherapy for advanced or recurrent endometrial cancer?
A pertinent question that we should hopefully know the answer to relatively soon. KEYNOTE-775 did not address this question. However, the LEAP-001 trial, a phase 3 randomized, open-label, study is investigating and comparing the survival outcomes of Pembrolizumab and Lenvatinib vs chemotherapy (carb...