Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What dose/fractionation do you use when treating SCC of the vagina with vaginal cylinder brachytherapy after EBRT?
Typically, we give 5Gy x 3Fx prescribed to a depth of 5mm. However, this may be more than necessary. See this discussion: https://www.themednet.org/question/270
At your institution how are cervical cancer patients managed who are intraoperatively found by frozen section to have positive pelvic lymph nodes?
At our institution if found intraoperatively then we abondon radical hysterectomy and treat with definitive chemo RT. Idea is to avoid increased complications with combination of surgery,RT and chemo vs. only chemo RT
How should a patient be treated when they have an isolated para-aortic recurrence after upfront chemotherapy and vaginal cuff brachytherapy for intermediate risk endometrioid endometrial adenocarcinoma?
We treat with salvage RT to involved nodal region (pelvis and pa if no prior EBRT and pa only if prior EBRT to pelvis) with concurrent and sequential or sequential chemotherapy using IMRT technique and using SIB dose with 55 Gy in 25 fractions to involved node and 45 Gy in 25 fractions to prophylact...
How do you logistically give sandwich chemotherapy and whole pelvis radiation treatment in advanced endometrial cancer?
We prefer concurrent or sequential. But in the past when we have done sandwich, we have used RT after 3 cycles of chemotherapy based on most of the published data.
How would you treat small cell cancer of the cervix?
Small cell carcinoma is a rare tumor, representing less than 3% of all cervical cancers. It is tremendously different from the more common squamous and adenocarcinomas of the cervix both in terms of histological identification and its clinical course. Due to its rarity and variable inclusion on prev...
In what situations should chemotherapy be added to adjuvant radiation therapy in a resected vuvlar SCC?
We did analysis from NCDB and saw significant trend of use of concurrent chemotherapy for node positive disease and its positive impact on survival. That being said these studies have their own flaws. In practice we do add concurrent cisplatinum for node positive patients if performance status allow...
What situations do you use IMRT vs 4-field box technique (or visa versa) for patients with an intact cervix with no pelvic or para-aortic nodal involvement?
The main argument is sparing of small bowel and marrow dose. Comparing the dosimetry of the two plans would give the answer as to whether there is any advantage in a particular patient as it varies based on anatomy, BMI, size of uterus and disease
Which chemotherapy regimen (if any) do you recommend for palliative concurrent chemoradiation for a symptomatic patient with metastatic cervical carcinoma and CKD stage 4 (GFR 15-29)?
For patients who cant get cisplatin because of poor kidney function, we have used taxol at 45-50 mg/m2 weekly ( metabolized through liver) based on phase 2 data. In our experience it is tolerated well.
How would you manage an endometrial cancer with no (or minimal) myometrial invasion and only a very small focus of disease in a pelvic node?
Eventhough stage IIIC endometrial cancer is the most common sub-stage among locally advanced patients, patients with node positive disease have routinely been combined with other stages for clinical trial purposes (including high risk early stage disease, stage IV, and recurrent disease). This not o...
How would you manage treatment of a cervical cancer in a patient unable to tolerate chemotherapy or an HDR boost due to medical commodities?
The first step is to be absolutely certain that brachytherapy is not feasible. In our experience this is extremely rare. The patient should have a thorough medical evaluation and have their medical conditions optimized as much as possible before the decision is made to withhold these standard elemen...