Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
For a patient with IIIC1 (micromets), MSI-high, Grade 2 endometrial adenocarcinoma who has undergone full surgical staging, do you recommend adding immunotherapy to adjuvant chemotherapy + radiation?
Short answer: No, I do not recommend adjuvant CT/IO + RT for this patient based on the patient's risk factors in the prompt, and the data below. Should the patient have recurrent/metastatic disease following adjuvant CT + RT/VCBT, then I/O + CT is a good option. Ongoing trials hope to answer this qu...
Should our selection for neoadjuvant chemotherapy in ovarian cancer patients change in light of COVID-19?
I see this as a two-pronged question where the response may vary based on the specific clinical situation, circumstances of the hospital, and status of the epidemic locally and regionally, along with available resources associated with the rapidly evolving COVID-19 pandemic. There is no question pri...
What would be your radiation boost technique and dose levels for adjuvant treatment of endometrial cancer with high-grade disease or aggressive histology if there was a positive margin at the parametrium after TAH+BSO?
I usually consider 50.4 Gy with EBRT followed by an additional 5.4 Gy to the parametrial region. Whether this additional boost helps is not known.
Would you include a seroma in an adjuvant radiation field for post-op endometrial cancer?
The general principle I follow is if I can include it safely, I would. Otherwise, would skip most of it (lymphocele). If lymphocele is the site of positive pathological node, then include it in CTV.
Is it necessary to include entire lymphocele in CTV while treating post operative nodal sites of pelvic malignancy?
I don’t know if necessary or not but I tend to include it if can do it safely. If large and pathological node was negative, then skip to reduce dose to OAR.
Do you sample radiologically negative paraaortic nodes in cervical cancer patients with clinically positive pelvic nodes prior to initiating primary chemoradiation?
Possible options in PET-positive pelvic nodes and negative PA nodes: Treat at least the entire common iliac chain, including the aortic bifurcation nodal region, which is 1 level above the affected pelvic nodes. Treat the subrenal PA region prophylactically, especially if the common iliac region or ...
How often do you believe para-aortic radiotherapy in addition to pelvic radiotherapy causes additional treatment breaks due to acute toxicity?
I would agree with @Dr. First Last that with IMRT and accurate definition of targets and organs at risk, that treatment can be delivered successfully. In patients who have had prior chemotherapy, attention to weekly blood counts is imperative. It is usually the platelet counts that pose a challenge....
When would you recommend surgical debulking of pelvic or para-aortic lymph nodes in cervical cancer prior to definitive chemoradiation therapy?
We have not favored dissection and treated with SIB and sometimes added sequential boost ( EQ@ dose 58-66 Gy) based on sizemost current literature shows excellent regional control but high distant failure in these ptsfor bowel and duodenum ( two organs which could be limiting factor) we use v55 dose...
What indications do you use to prophylactically treat para-aortic lymph nodes in cervical cancer?
The answer to this question is not simple although there are some general rules that we use. First, I should mention that for patients with locoregionally advanced disease, we now usually treat to the bifurcation of the aorta as a minimum. This generally puts the upper border close to L3/L4. We bega...
How are you counseling HR-proficient ovarian cancer patients about front line PARP inhibitor maintenance?
I think this is a tough decision, but I recommend observation for patients with HR proficient disease. In brief, I don't find a PFS advantage, without a proven OS advantage, enough to justify this long-term, expensive, and not non-toxic treatment.For BRCA carriers the answer is easier—with SOLO2 (20...