Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
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...
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...
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...
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...
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
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.