Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What adjuvant therapy would you offer a fully resected isolated pelvic peritoneal recurrence of a uterine serous carcinoma?
Although the recurrence appears to be isolated, peritoneal recurrence of serous endometrial carcinoma suggests more than localized disease, thus systemic therapy is appropriate. Because the most common site of another recurrence is in the vicinity of the resected metastasis, stereotactic local radia...
What starting dose of lenvatinib are you ultilizing in recurrent endometrial cancer patients initiating lenvatinib/pembro?
I start with 20 mg daily. I base this on the recent study by Makker and colleagues
How would you manage recurrent endometrial cancer limited to pelvic and inguinal nodes in a patient with no previous radiation?
If it is a delayed recurrence, we usually treat nodal regions only (going one level above involvement) with IMRT and concurrent weekly cisplatinum chemotherapy with SIB boost to node followed by possible adjuvant chemo.
When do you include the mesorectum for definitive cervical cancer patients getting concurrent chemoradiation followed by brachy?
I would also include it if there is direction invasion into the mesorectum or EMVI.
How would you treat a stage IA mixed carcinosarcoma/neuroendocrine tumor of the endometrium, negative LNs?
This is definitely an interesting question. Given the high-risk histology, I would want to ensure that a gynecologic pathologist has confirmed the histologic diagnosis as well as have imaging (either CT chest/abdomen/pelvis or PETCT skull base to mid-thigh) to ensure there is truly no extra uterine ...
How would you approach treatment for centrally recurrent cervical SCC with positive margins after excision that was not exenteration?
We treat with concurrent chemo RT with EBRT plus brachy. Total dose of brachy is based on the extent to residual disease. For positive margin as above with non oncological resection, 65-70 Gy equivalent dose. Would get MRI of pelvis with vaginal gel to assess any residual disease.
How would you treat an isolated para-aortic node recurrence 1.5 years after receiving primary chemoradiation for locally advanced cervical cancer?
We treat with definitive chemo RT to pa region using IMRT (weekly cisplatinum with 45 in 25 to pa region and 55-57.5 Gy in 25# SIB to node). Small bowel and duodenum dose constraints (V55 < 5 cc and V55 < 1cc respectively).
What would be your treatment approach for a patient with a new PET positive para-aortic node 3 months following completion of definitive chemoradiation for locally advanced cervical cancer?
My approach would be to treat the entire para-aortic field (above the previous field, obviously) to approximately 45 Gy with conventional fractionation, followed by a boost to the PET positive node to get to a dose of 60 Gy or so, if possible, while respecting the relevant tolerances. If the volume ...
What dose fractionation would you use on a large retroperitoneal recurrence of cervical cancer that is extending to previously treated 5040cGy pelvis?
Favor starting with chemotherapy, and planning RT based on response to chemo as volume and dose can be adjusted based on response.
What palliative regimen do you use for intra-pelvic recurrence of cervical cancer after definitive chemoRT with T&O brachytherapy?
Based on performance status, expected survival, the time elapsed from previous RT, and volume to treat, have used quad shot to 24-30 in 12 to 15 fraction or salvage HDR interstitial to EQ2 dose of 40 Gy or so.