Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
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 ...
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?
Would need to determine if this is indeed a cervical primary or possibly an endometrial cancer with cervical involvement. Would order a TVUS and counsel the patient to undergo LLETZ or cervical conization. Would also need to know the depth of invasion.
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.