Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
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.
How does your approach to the primary treatment of glassy cell carcinoma of the cervix differ from the primary treatment of squamous cell or adenocarcinoma of the cervix?
No difference.
Do you treat an endometrial cancer that is microsatellite-stable but has a high TMB after progressing on platinum-based therapy with pembrolizumab?
Yes I would. Similarly, I would also treat a patient with advanced cervical cancer with Pembrolizumab. I have a patient with PDL1 negative, TMB-High squamous cell carcinoma of cervix. Submitted to insurance for coverage and she is approved for Carbo-Taxol-Bev-Pembro. It is absolutely worth a try and...
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...
Given the negative results of GOG-0238 but the positive results of the RUBY trial, how do you manage isolated vaginal cuff recurrence of endometrial cancer?
I would favor definitive RT alone and reserve chemo plus IO for systemic or nodal relapse.
Do the results of the ConCerv and SHAPE trials alter how you might counsel a patient incidentally found to have ≤IB1 after simple hysterectomy?
The ConCerv and SHAPE trials have demonstrated that selected patients with low-risk, less than or equal to stage IB1 cervical cancers can be safely treated with simple, extrafascial hysterectomy with lymph node assessment. Given those findings, if a patient met the criteria for inclusion in the ConC...
What is the biggest mistake people make when using IMRT to treat cervical cancer?
I can't say for sure what the biggest mistake people make is, but some common issues I see when reviewing others' contours are: Using insufficient margins around the vessels when contouring the nodal volume (CTV) Using insufficient planning margins around the vaginal cuff (postop) or cervical mass/u...
Do the number of lymph nodes removed in a non-Stage IA/FIGO 1 endometrial cancer case, affect your decision for WPRT v. vaginal brachytherapy alone?
Yes, in some cases it does—for two reasons. If a patient has had an extensive negative node dissection, the risk of extravaginal pelvic failure is undoubtedly less and the risk of RT complications may also be greater than if the patient had hysterectomy only. These factors define the “therapeutic ga...
How would you approach the management of a patient with locally advanced cervical cancer as well as synchronous endometrial adenocarcinoma?
The short answer is--treat both malignancies with a therapeutic plan that addresses them both. While the question fails to provide the details necessary to navigate the particular situation, some guiding principles can be asserted. 1. Intensity of therapy should be proportionate to the more dangerou...
What is the role of parametrial and pelvic side wall boosts in the setting of volumetric brachytherapy for locally advanced cervical cancer treated with either 3DCRT or IMRT?
The rationale behind the parametrial/side wall boost could be one or both of below 1. Treating the parametrium 2. Boosting involved pelvic nodes If it's done for an additional boost dose to the involved nodes, then the nodes should be contoured and dosimetry should be done to ensure coverage of invo...