Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you sequence vaginal cuff brachytherapy with EBRT for post-op endometrial or cervical cases that require both modalities?
We do sequential without any break after EBRT
Would you recommend systemic therapy in a patient with a history of Stage III high grade serous endometrial cancer s/p resection of a solitary pulmonary metastasis after a long disease free interval?
Systemic therapy should be advised in this patient with recurrent serous endometrial cancer after surgical resection of oligometastatic disease and a long disease free interval. Before advising a specific therapy, pathologic review by an expert gynecologic pathologist for both histologic confirmatio...
Would you offer adjuvant chemotherapy in addition to pelvic RT in a patient with fully resected pelvic recurrence of endometrial carcinoma?
For endometriod histology For nodal relapse, we do offer adjuvant chemotherapy, extrapolating from benefits seen in stage III disease, but not for isolated vaginal relapse.
In a patient with a vaginal cuff recurrence from endometrial cancer not amenable to interstitial brachytherapy, how would you boost after 45Gy?
If not amenable to brachy which is unusual in our practice, we would use IMRT boost to 66 to 70 Gy.
Which tumor markers, if any, would you use to follow patients with high grade or advanced endometrial cancers?
Elevated initial CA 125 has been associated with increasing tumor size, higher stage, poorer survival, and risk of recurrence in patients with high-grade uterine cancers. I do follow these women with serial testing throughout and after their initial treatment. Hoping that we will identify more speci...
In patients with metastatic/persistant/recurrent cervical cancer who have completed platinum-based chemotherapy with bevacizumab, do you offer maintenance bevacizumab?
Currently, I do not offer maintenance bevacizumab to these patients as there is a lack of randomized control data to support this. I treat these patients accordingly to the GOG-240 trial which continued treatment with chemotherapy plus bevacizumab vs chemotherapy alone until disease progression, una...
Would you consider fertility-sparing management of stage IB1 cervical cancer using NACT followed by conization?
No, I would not consider neoadjuvant chemotherapy (NACT) and conization for this patient outside of a clinical trial. Two ongoing prospective clinical trials are currently evaluating NACT for fertility preservation in Stage I and II disease and may provide future clinical guidance on oncologic outco...
Would one expect any significant response of pulmonary metastases with usual dosage of weekly cisplatin during definitive chemoRT for cervical cancer?
This is a great question that we have definitely discussed at our tumor board. Any systemic therapy has the potential to create a response to pulmonary metastasis, however dosing, timing, and duration of treatment all play into how much response is expected. In this setting, I would definitely want ...
Based on the data from GY018 and RUBY, do you offer immunotherapy in addition to carboplatin/paclitaxel first line to all patients with advanced endometrial cancer who qualify or only to those whose tumors are MMR protein deficient?
This is a timely question that many of us are struggling with. There is a shared desire to improve clinical outcomes in patients with metastatic, advanced pMMR EC. As you know, both the NRG GY018 and RUBY regimens were NCCN compendium listed after publication and simultaneous presentation. Important...
In the context of the ConCerv and SHAPE trials, how would you approach a patient with endometrioid adenocarcinoma within an excised 1.2 cm cervical polyp (negative for LVSI) who has no suspicious lymph nodes on CT scan?
I would ensure that the polyp was fully removed and attempt to determine whether it is of cervical or endometrial origin. Either way, however, I would discuss fertility-preserving surgery versus definitive surgery. If fertility-preserving, then I would consider a CKC with sentinel lymph nodes, versu...