Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What indications do you use to prophylactically treat para-aortic lymph nodes in cervical cancer?
The answer to this question is not simple although there are some general rules that we use. First, I should mention that for patients with locoregionally advanced disease, we now usually treat to the bifurcation of the aorta as a minimum. This generally puts the upper border close to L3/L4. We bega...
How do you decide whether to treat proximal vs. entire vaginal cuff with intracavitary brachytherapy in early-stage endometrial adenocarcinoma?
At M.D. Anderson - we never treat the entire vagina for early stage endometrial carcinoma. In fact, we only treat the proximal 2.5 to 3.0 cm of the vagina in most case but may increase with by 1.0 cm for patients with papillary serous or carcinosarcoma histology with brachytherapy. We have excellent...
In a pre-menopausal female with cervical cancer, would you boost a hypermetabolic ovary on PET?
Hypermetabolic ovary is very common and physiologic in premenopausal women and I would not boost that area. MRI pelvis can confirm benign nature of this uptake
Would you recommend adjuvant radiation for well-differentiated gastric-type adenocarcinoma of the cervix, stage 1b without LVI?
Our tumor board evaluates each case for both Sedlis (GOG 92, PMID:10329031) and Peters (GOG 109, PMID:10764420) regardless of the histologic subtype to determine adjuvant therapy. Here with the deep invasion if the tumor size is >=4cm we would offer adjuvant radiation. You are correct in that there ...
What clinical factors would lead to utilizing a tandem and cylinder rather than tandem and ovoid for cervical cancer brachytherapy?
Tandem and cylinder should be used with caution as it is hard to cover the entire cervix and paracervical region with tandem and cylinder. If the patient has lower vaginal disease with good response to chemo RT, one can use tandem and cylinder but may need some needles to cover entire cervix.
How does sarcomatous overgrowth in a uterine carcinosarcoma change your management of adjuvant therapies?
I tend to treat carcinosarcomas as high-risk endometrial cancers, with carboplatin/paclitaxel adjuvant chemotherapy, +/- vaginal cuff brachytherapy for early-stage disease. Adjuvant radiation for early-stage disease is also a consideration, as carcinosarcomas may have some improvement in local contr...
What is your institutional protocol for an incidental finding of an adnexal cyst on CT simulation for cervical cancer?
It is not common to have this finding. A combination of PET CT and MRI confirms the benign etiology of these cysts and can be ignored for cervical cancer management.
For a recurrent, MSI-H endometrial cancer, do you usually treat with Pembrolizumab alone or in combination with Lenvatinib?
Alone.
Would the presence of multifocal LVSI change your adjuvant treatment recommendation for a surgically staged IA dedifferentiated endometrial carcinoma?
Dedifferentiated is considered a high-grade lesion. There is admittedly low quality evidence on optimal management given lower incidence.I would recommend treatment with vaginal brachytherapy and very much offer chemotherapy. Would prefer vaginal brachytherapy, given the patient was surgically stage...
How does number of ITC influence your approach to adjuvant RT for a surgically staged 1B endometrial cancer meeting HIR criteria?
Management of ITC only in the setting of SNLN is not defined well. We know ITC has a much better prognosis than micromets and macromets. We also know that even with ITC after SNLN bx only, there is risk of additional residual nodal disease left behind which may need to be addressed. What we don’t k...