Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What is your surveillance approach for outpatient monitoring of ICI myocarditis?
Screening and surveillance strategies for outpatient monitoring of ICI myocarditis are not well-defined. The best surveillance approach would be based on clinical risk assessment, followed by biomarker and imaging data. The risk factors for ICI myocarditis remain to be clarified, but the most valida...
With COVID-19 worries, are you more likely to offer women with endometrial cancer vaginal cuff brachytherapy over EBRT?
I would treat with brachy alone, as even in a non COVID environment with her comorbidities, the benefit of EBRT is minimal in terms of survival.
In a patient with locally advanced cervical cancer that has extensive residual disease (>7 cm in greatest dimension) after chemoradiation, how do you weigh the geometric advantages of a Syed-Neblett template against the superior toxicity profile and outpatient feasibility of an advanced hybrid applicator?
Kilar et al., PMID 41737510, explains applicator selection. If residual disease is less than 4 cm on either side (still a total of 7 cm), a hybrid with straight and oblique needles can help to cover the disease. However, if it is more than 4 cm on one side, then you have to look at geometry, and som...
Given the results of PORTEC-4A, what adjuvant therapy, if any, would you offer a patient with a POLE-mutant endometrial cancer who also has a p53 mutation and substantial (>5 foci) of LVSI?
When you have dual mutation, the better of the two mutations drives the outcome, so it would be treated like a POLE-type. If substantial LVSI and pathological nodal assessment are done, I would favor Brachy alone. If nodes are not assessed, I would favor EBRT. The link below has references about dua...
For a patient with locally recurrent endometrial cancer whose disease had complete radiographic response to carboplatin, Taxol, and pembrolizumab, would you consider adding radiation therapy?
Despite having a complete response to chemoimmunotherapy, I would tend toward adjuvant RT since this was a local recurrence. We don't have long-term data with chemoimmunotherapy in this locally recurrent setting.
What is your approach to neoadjuvant treatment for uterine carcinosarcoma with peritoneal metastases prior to surgical debulking?
Uterine carcinosarcoma is treated as a high-grade epithelial endometrial carcinoma, and for a patient with peritoneal metastases who is not a candidate for upfront optimal cytoreduction, the standard neoadjuvant approach is systemic chemotherapy with carboplatin/paclitaxel followed by re-evaluation ...
In what situations in gynecologic radiation would you consider using a vaginal marker for CT simulation and daily treatment?
In my opinion, the most important indication for using a marker is in the situation of cervical or uterine cancers that extend distally into the vagina. The vaginal extent of disease is almost never well-visualized on CT or even MRI. Direct visualization and palpation, with seed marker placement, re...
What adjuvant treatment would you recommend for a patient with FIGO 2023 IIIB2 endometrioid endometrial adenocarcinoma (Grade 3, p53mut, MMR proficient), metastatic to the uterine serosa, bilateral ovaries, and anterior peritoneal reflection?
Chemotherapy followed by pelvic RT
Based on the data from GY018 and RUBY, do you offer immunotherapy in addition to carboplatin/paclitaxel first line to all patients with advanced endometrial cancer who qualify or only to those whose tumors are MMR protein deficient?
This is a timely question that many of us are struggling with. There is a shared desire to improve clinical outcomes in patients with metastatic, advanced pMMR EC. As you know, both the NRG GY018 and RUBY regimens were NCCN compendium listed after publication and simultaneous presentation. Important...
How do you manage moist desquamation when treating vulvar cancer?
My experience is largely limited to the treatment of gynecologic malignancies, with the treatment of vulvar lesions the most common reason for development of moist desquamation. The first goal, in my opinion, is to prevent development of moist desquamation as much as possible. Skin folds that are no...