Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What is your adjuvant therapy for node positive, low grade endometrioid endometrial adenocarcinoma?
Chemotherapy (typically carboplatin/paclitaxel x 6 cycles), restage, and if no progression, whole-pelvic RT. Consider brachytherapy boost if cervical stromal or vaginal involvement and/or presence of other risk factors for vaginal cuff recurrence (e.g. LVSI, deep myometrial invasion, grade 3 [not in...
How would you manage a bulky, locally advanced endometrial cancer with extensive parametrial involvement in a patient inoperable due to medical comorbidities?
PET CT staging. If suitable for definitive treatment, EBRT (concurrent chemo if able to get it) plus HDR brachytherapy.
Do you follow GOG, ASTRO, or PORTEC recommendations for adjuvant therapy in stage I endometrial cancer patients?
I believe the current ASTRO guidelines encompass the older GOG and PORTEC guidelines for the most part and we follow these guidelines though we review all for the sake of completeness.For the first patient, barring other risk factors, I would offer adjuvant vaginal cuff brachytherapy; for the second...
If a patient with MSI-H endometrial cancer slowly progresses on single-agent pembrolizumab, would you add lenvatinib?
This is an important question without a defined answer at this time. In a prior phase 2 trial examining cabozantinib + nivolumab in endometrial cancer, a small exploratory cohort of patients treated with prior IO was included. Of 20 patients who received prior IO, six patients responded and eight ha...
When would you offer extra-fascial hysterectomy to patients with low-risk early-stage cervical cancer in light of data from the ConCerv trial?
Stage 1A1 and 2
Is there a role for chemotherapy and/or vaginal cuff boost to EBRT in FIGO IB1 cervical adenocarcinoma, status post total hysterectomy?
Recently presented SHAPE trial shows non-inferiority of simple hysterectomy to radical for IB1 disease or lower disease. So for the above patient, that may not change anything but certainly would need nodal assessment which could be from surgery or RT after PETCT.
Would you consider offering immunotherapy +/- olaparib to a patient with early-stage endometrial carcinoma for whom you are recommending adjuvant chemotherapy based on improved outcomes seen in RUBY/DUO-E/NRG-GY018?
I hesitate to offer the chemo/IO combination to patients with stage I disease as this is likely an overtreatment. The majority of the patients who require chemotherapy for stage I disease are those with serous and carcinosarcoma histology. Most of those patients are not even MMRd. It is unclear what...
Do you ever alter dose/fractionation for early stage endometrial cancer patients receiving vaginal brachytherapy alone?
There are several commonly used regimens for vaginal brachytherapy alone. In GOG 249, the following regimens were allowed:HDR 6-7 Gy x 3 fractions, weekly, prescribed at a depth of 0.5 cm from the surface of the vagina.HDR 10-10.5 Gy, x 3 fractions, weekly, prescribed at the vaginal surface.HDR 6 Gy...
In light of the ongoing GOG 263 trial, do you consider adding concurrent chemo with RT for early stage cervical cancer as adjuvant after Rad Hyst off trial?
Adjuvant treatment is indicated after radical hysterectomy if pathologic risk factors are discovered. The GOG 92 trial with node negative intermediate risk patients had recurrence free survival rates of 88% for adjuvant RT versus 79% for the no treatment group. Longer term follow up shows PFS and tr...
Do you recommend stopping olaratumab in patients receiving doxorubicin/olaratumab for treatment of advanced sarcoma?
Yes, we have stopped since this data came out. Am continuing either with single agent doxorubicin or addition of a second agent such as ifosfamide in select patients.