Gynecologic Oncology
Questions discussed in this category
She had a resected FIGO grade 2 endometrioid adenocarcinoma and did not receive radiation then. Her recurrent disease was a bulky pelvic mass that mel...
On the one hand, the addition of immunotherapy should increase a patient's likelihood of treatment response, so perhaps persistent disease in this set...
That nodal region has previously received 55 Gy in 25 fractions.
Certainly the distant disease makes the risk of recurrence after exenteration very high. On the other hand, the patient is 2 years out from initial tr...
Do you offer observation for POLE mutated tumors?
Interstitial implant was attempted under laparoscopic guidance (due to pre-brachy MRI showing potential bowel involvement). At the time of procedure, ...
Could you discuss how you decide between IMRT or SBRT boost for a patient who is not able to receive intracavitary or interstitial HDR or LDR brachyth...
There is conflicting data on whether the "surprise question" performs adequately enough. Do you use this or other screening tools alone, or in c...
How do you incorporate this into your follow-up care and how do you instruct the patient?
If the lesion is bulky and cannot be excised, would you treat with additional EBRT, or interstitial brachytherapy alone, or a combination thereof?&nbs...
Is there any evidence that variation in schedule (once weekly vs. every other day in between cycles) can affect outcome? Does this vary with dose pres...
If so, will you recommend it universally or only for certain patient population(s)?
She required an episiotomy intraoperatively just to perform an EUA/biopsy. She may not tolerate vaginal cylinder insertion and even if she can, I am u...
What volumes would you treat for the primary?
Would your management change given that this recurrent lesion is over 10 cm and the patient previously achieved complete response on immunotherapy 5 y...
The patient received adjuvant chemotherapy and had an unrevealing staging PET/CT.
The 4 cm cuff recurrence occurred 3 years after definitive treatment with hysterectomy and vaginal cuff brachytherapy to 21 Gy. The recurrence had a c...
Would you offer additional adjuvant treatment (e.g., pelvic EBRT, vaginal brachytherapy, etc.)?
Is there a subgroup of patients who benefited significantly from a specific protocol?
Are there data from trial patients who recurred, especially regarding what treatments they received?
Would you deliver definitive RT in place of inguinal lymph node dissection in light of new data (Stecklein et al., PMID 29336837)In the case of high-r...
How do you distinguish whether toxicity is related to the immunotherapy vs the radiation vs both? Are you seeing higher rates of these due to the comb...
What do you think is the role of radiation for this patient and how should it be timed?
The patient is a female in her 40s. No mucosal changes were evidenced on clinical exam. Chemo-RT is recommended by GynOnc at an academic center. ...
Surgical pathology found close medial margin but no other adverse features. Would you favor omission, VBT, or EBRT?
Please comment on toxicity profiles and the insufficient evidence regarding overall survival.
The patient is a female in her 60s, HIV+ since age 19, and has a current CD4 total count of 20. She has a 7 cm primary cancer without involvement of v...
HER2 status is pending
What would be the dose and volume to treat?
Given the data from both INTERLACE and KEYNOTE-A18, how would you design a clinical trial to best answer the question on optimal management of locally...
If a patient with a positive node just above the common iliac bifurcation, and will be treated with chemoradiation --> pembrolizumab according to A...
What type of bolus configuration do you favor in these settings?
Examples include bulky cancers involving curved surfaces in challenging head/n...
There is no evidence of distant metastatic disease, though there is possible residual unilateral parametrial involvement.
Would a drop from 5,000 to 1,500 in this setting alter your decision to proceed to the OR?
Do other factors influence your decision?
Is there any evidence to suggest it matters if you use tissue from their initial biopsy/surgery vs tissue obtained from a new biopsy at recurrence?
What are your volumes and dose/fractionation for external beam boost in lieu of tandem and ovoid or tandem and ring implant?
Tumor is HER2 3+ on IHC staining.
Do you think it works better if incorporated as early as possible in the patient's course, or is it better to "save it" for future recurrences after u...
If someone progressed on mirvetuximab, would you consider adding bevacizumab before discontinuing mirvetuximab?
In particular, have you seen dose-limiting diarrhea, ocular toxicities, or infusion reactions?
For some patients, it may be overburdensome to make an extra trip to an ophthalmologist every other cycle. They may live far away from an ophthalmolog...
If so, what dose would you recommend? What other management options would you consider?
What is the reasonable expected benefit to be gained, if any?
In what circumstances would you offer adjuvant radiation after resection of vulvar mucosal melanoma?
If so, what would your target volumes and doses be? How would you sequence with immunotherapy (eg nivolumab)?
If so, what do you typically prescribe?
Would you consider the addition of carboplatin/paclitaxel + dostarlimab to radiation as opposed to radiation alone?
Assume surgery is not an option. Would you encompass the entire involved muscle and treat with fractionated RT, or would you use SBRT to treat the dis...
Surgical pathology found negative pelvic/inguinal nodes, but revealed also focal LVI/PNI
Would you consider this stage IVA (spread to adjacent organ) or IVB (spread to distant organ)? For instance, would the presence of direct lumbar verte...
Re-staging is otherwise negative; patient's disease has FIGO grade 1 endometroid histology
How do you advise patients who strongly desire chemotherapy?
What is your general philosophy when discontinuing and/or switching chemotherapy in the recurrent setting?
Would you still discuss the option of parametrectomy/upper vaginectomy if they would have met the criteria for SHAPE?
Do you recommend completion hysterectomy after completion of child-bearing?
Pre-op stage was IB2, but post-op: tumor 4.5 cm, negative margins, no LVSI, 6/15 mm depth of stromal invasion, negative SLN.
Would you consider standard definitive chemoRT (EBRT + HDR brachytherapy)?
Cervical cancer FIGO stage IIIC2. Bloodwork shows elevated ESR and CRP.
No LN dissection was performed as it was for a suspected CIN III. Final pathology showed +LVSI, -margins (>10mm), -parametrial extension, and 1.2mm...
When, if ever, do you utilize adjuvant RT or chemotherapy?
The patient is in her 70s, was first diagnosed with vulvar cancer two years ago, and underwent a radical vulvectomy with clear margins and negative ly...
The patient has undergone a vulvectomy years ago. The disease now involves the vulva, perineum, and peri-anal regions.
What is your practice when you have a neutropenic cervical cancer patient undergoing chemoradiation?
Patient with active rheumatoid arthritis, on escalating dose of Rituxan and Methotrexate, also has antisynthetase syndrome and Hashimoto's thyroiditis...
For a woman with complete resection of serous intraepithelial carcinoma of the endometrium, would you recommend adjuvant radiation or chemotherapy? Wh...
This is a less common histology in the vulva.
Are there any creams or suppositories that can be safely applied internally in the vagina to soothe burning?
How would you manage a FIGO IA G3 endometrial cancer with no LVSI, lymph nodes not sampled but CT a/p negative for lymphadenopathy, yet 2 foci of canc...
“Recent evidence” suggesting this was brought up in tumor board to justify excluding whole pelvic RT for a IIIC1 patient but I can’t...
This would apply to gynecologic and GI cancers as well. And as long as the patient's partner is within the recommend age of <45 yo
There was a recall on viscous lidocaine and many of our patients cannot find it. What would you recommend as alternatives?
The patient was initially treated with Carboplatin/Paclitaxel and progressed after 1 year. She was switched to pembrolizumab and had significant progr...
Are there certain patient subgroups for whom you would use the IO+PARPi?
Is there data from DUO-E regarding BRCA status and its potential impact on ...
In the PORTEC LVSI grading system, 3 or more vessel are classified as extensive LVSI, while the FIGO 2023 Endometrial Cancer staging they reference WH...
If so, what dose would you treat to the resection bed?
If so, what dose/volume is prescribed? How do you account for motion?
At what point does the benefit of either post-operative vaginal cuff brachytherapy, or vaginal cuff brachytherapy boost following EBRT for endometrial...
Or would a typical prescription, such as 7 Gy x 3 Fx to 5 mm depth be reasonable for typical sizes 2.5-3.5 cm? Per ABS guidelines, they specify that t...
Would you consider VBT alone vs EBRT and/or offer chemo?
This is a female in her late 60s with FIGO 2023 IIB disease given substantial LVSI+ (>5 v...
Have you been able to deliver standard of care treatment?
If yes, would you apply this broadly or reserve the addition of IO to chemotherapy for patients with high-risk histologies (e.g., carcinosarcoma) or o...
Does your decision depend on MMR status? Would you use the same approach for neoadjuvant treatment?In light of relevant trials including RUBY, GY018, ...
DUO-E, GY-018, and RUBY included patients with stage III and IV endometrial cancer WITH measurable disease.Would your decision change based on the mis...
Are there patients for whom you would still reserve IO for salvage/recurrent setting (eg IO + lenvatinib)? Would you base this on MMR status or other ...
Given this histology, does the groin need to be covered? Would you add chemotherapy?
Oftentimes the needles were inadvertently pulled. Without using a template, are there any methods to mitigate this risk of compromising implant qualit...
Is there high quality data to support debulking in terms of oncologic outcomes? Does HPV/p53 status impact your decision?
How do you counsel patients and caregivers? Do you prescribe medications (''appetite stimulants'') with the goal to improve appetite even if they do n...
What would you recommend for a patient in their 60s with stage IB grade 1 endometrial cancer without LVSI? How would this differ for a patient with st...
Do you proceed with sequential, concurrent, or sandwich treatment?
Patient with a locally advanced, node-positive vulvar cancer status post inguinal node dissection with persistent output in drain (for about 8 weeks) ...
For example, do you think young patients might potentially benefit from the addition of cisplatin, knowing the average age in this study was 65.
GOG 205 treated vulvar cancer patients to a dose of 57.6 Gy to sites of gross disease, which is somewhat less than what is suggested in cases of defin...
Example: in a patient with a non-resectable pelvic mass involving the vagina but without evidence of distant disease, would you favor pelvic RT (as on...
What is considered the optimal interval from time of excision, partial, or radical vulvectomy and/or nodal dissection to initiation of post-op RT?
Do you prefer surgery (i.e. exenteration) given the radioresistant histology or would you attempt to manage with EBRT and brachytherapy?
The patient also declines any brachytherapy treatment.
Her primary disease is too large for any brachytherapy; if substantial residual disease remains, how would you approach external beam boost?
This is a patient in her 70s who previously received 5040 cGy adjuvant EBRT alone to the pelvis.
Aside from limit due to extent of her hysterectomy, the patient's disease does not otherwise satisfy Peters' criteria
How will you translate treatment recommendations from older studies to the new staging system?
A patient in her 70s initially underwent TAHBSO + LNB with Stage I, G1 cancer, No LVSI. 18 months later with very small mucosal recurrence (5mm). HDR ...
Does the presence of parametrial or cervical involvement impact your decision?
How do you sequence treatment modalities?
This case involves an impressive ‘high volume’ vaginal recurrence and patient was not originally planned for adjuvant therapy. Concerned t...
NCCN cervical cancer guidelines added a new statement - Patients who have received prior pelvic radiation therapy and have osteoporosis may benef...
Would the extent of nodal involvement sway you one way or another (i.e., a micromet in a single sentinel node)?
Consider treatment of stage IVB cervical cancer with systemic therapy and local pelvic radiation therapy as in Perkins et al., PMID 31810653.
If a patient is found to have multiple painful osseous lesions but is chemotherapy naive, do you typically wait for the patient to undergo treatment w...
Do you wait until chemotherapy completion, interdigitate between cycles 1-2 only when feasible, or between any cycle of chemotherapy?
What factors wo...
Does stage of the cervical cancer influence your decision? Does the amount of SUV uptake influence your decision? When does one biopsy? How long can o...
Does your surgical approach vary based on patient age, comorbidities, or tumor type?
At our institution we often give 5.5 Gy x 4 fractions. There really does not appear to be a general consensus regarding timing. Interested in what oth...
Since there is no overlap between chemo regimens for these cancers, how would you sequence treatment?
If you do not review all imaging, how do you triage for which studies you personally review the images vs. the written interpretation only?
Assuming patient is <45 years old with cervical, vulvar, vaginal, anal, or head/neck cancers, or with CIN/VIN/VaIN/AIN/oropharyngeal precancerous l...
Considering this is stage IV disease, do your recommendations for definitive or adjuvant treatment (after surgery) change?
If a patient had a remote history of pelvic radiation for another cancer and now has uterine cancer, what factors (grade, stage, KPS, LVSI, etc) would...
Would there be a survival advantage to pelvis RT with deep myometrial invasion, LVSI and ITC?
Would you consider chemoRT or carbo/taxol/immunotherapy?
In what scenarios would you consider observation versus alternative adjuvant treatment modalities?
Bone marrow preservation is important due to poor hematologic function. Chemotherapy is not possible as well.
If the radiation cystitis is hemorrhagic without clots how would you manage this?
What instructions do you give your radiation therapists - do you rely on OAR identification (ie. bladder and rectum filling) or soft tissue match to t...
Do you give cuff and chemo or pelvic CRT or chemo alone?
Patient with h/o appendiceal carcinoma s/p surgery and HIPEC, now with endometrial cancer, IBG3, extensive LVSI, pNx, recommended for whole pelvic rad...
Would you offer pelvic RT or intracavitary brachytherapy?
Considering the ASTRO guidelines recommend against systemic therapy for patients with FIGO stage I-II endometrioid adenocarcinoma, would your recommen...
Is this an artifact of what agent prior clinical trials used or something to do with the mechanism of action (i.e., less mineralocorticoid effect of d...
MRI pelvis shows a 3.5 cm primary that appears infiltrative and without clear parametrial extension on MRI. Staging PET negative.
Is there any ...
Do you extrapolate from first line maintenance studies for duration of therapy?
Does the patient's MMR status affect your opinions? What is/are your current preferred second-line regimen(s)?
Mesonephric is described as a higher grade histology. For a superficially invasive IA (no LVSI, age < 60), would you consider vaginal brachytherapy...
Would your recommendation change if the patient was platinum-resistant?
Considering updated trials, such as final OS data from NOVA, and recent society guideline updates?
Front-line PARP inhibitor maintenance therapy discontinued without progression.
If yes, would you consider a minimally invasive approach despite the LACC trial results?
If no, what additional research/information is needed to cha...
Given the crossover that occurred in the various clinical trials and the potential for prolonged disease duration, how do you integrate OS, PFS, treat...
Does the exact time since last platinum-based chemotherapy change your answer?
Does your approach change depending on the patients initial somatic BRCA status?
The patient is >40 yo with Lynch syndrome and a history of endometrial hyperplasia status post R0 TAH/BSO with SLNBx for a 5.2 cm, grade 3 adenocar...
Please specify how your institution is allocating resources now or will be soon.
(i.e. frequency of serial BNP, troponin, cMRI)
Do you treat the whole bladder in the intial whole pelvic field to 45-50 Gy?
The recurrence is mucosal and inferior to the prior field.
Surgery remains an option. Given favorable response, would you recommend pre-op or definitive RT +/- chemo?
Close but negative radial margins? LVSI? What fractionation/dose do you use for your vaginal cuff boost if used?
ConCerv trial: Schmeler et al., PMID 34493587
The patient is not a candidate for re-resection or external beam radiotherapy
7 cm tumor limited to the cervix with no vaginal or parametrial invasion on exam and not lymphadenopathy or metastatic disease on imaging. Cystoscopy ...
If you do not use the PORTEC-3 regimen for p53 mutated IA endometrial cancer, what specific protocol or combination of chemotherapy and radiation ther...
Does not involve surface surface of the ovary, no gross disease elsewhere.
How do you take into account pathologic factors like %clear cell histology, myometrial invasion, and LVSI?
Or would you reserve its use to stage III-IV or recurrent disease (as in Fader et al., PMID 29584549)?
Since there is no overall survival benefit, does the local control benefit outweigh the increased risk for distant metastasis? How do you select patie...
If the patient had high risk features (for example age 60+ and LVI) do you treat with vaginal brachytherapy or WPRT? If you treat with whole pelvis ra...
Do you offer 3 or 6 cycles of chemotherapy? Would you ever observe?
Would you recommend if there is only one uterine factor or do you typically require multiple to make this recommendation?
Occult IB1 cervical SqCC found on simple extrafascial hysterectomy, with 4 mm deep stromal invasion and LVSI. Subsequent pelvic and para-aortic nodal ...
Please consider this National Cancer Database (NCDB) and Surveillance, Epidemiology, and End Results Program (SEER) registry study (Barrington et al.,...
What factors would push towards treatment? The patient had recurrence of a pT1bN0 vulvar SCC within a year of original surgery. Re-resection shows aga...
How do you "have the talk" in a way that is straightforward without emotionally crushing the patient?
How can these interactions be improved?
When would you use 5-fluorouracil instead of, or in addition to, cisplatin during chemoradiation?
When would you use 5-fluorouracil instead of, or in addition to, cisplatin during chemoradiation? When, if ever, would you offer adjuvant hysterectomy...
Imaging reveals no evidence of disease.
The right obturator sentinel node had a 1.5mm metastasis with no ece. Additional right pelvic node and 6 left pelvic nodes are negative. The cervix ma...
There is evidence that parents do not adequately understand the purpose of phase I pediatric cancer trials (Cousino et al., PMID 23071225).
For example, concerning throbocytopenia or neutropenia during anal cancer treatment with concurrent mitomycin/5FU, or other pelvic malignancies treate...
In the absence of other high risk factors like positive/close margins, positive lymph nodes, T2/T3 disease, PNI, or LVI, would you offer postop RT?
Ideally, treatment should be completed in 56 days (preferably < 50 days). If there has been a significant delay to brachytherapy (>2-3 months) d...
In your practice, what is the proportion of patients receiving neoadjuvant chemotherapy who are diagnosed with VTE? Does this differ from patients rec...
Female in her 60s who had presented originally with well-differentiated endometrioid adeno clinically and radiographically involving bilateral paramet...
Would your systemic therapy choice be more similar to treatment of ovarian carcinoma or soft tissue sarcoma?
How does your approach differ for patients under age 60, between 60-70, and over age 70?
Do you assume some recovery since the prior course of RT? If so, how much over what time period?
Still do Tandem and Ring or opt for interstitial?
Patient will have diverting colostomy. Concern is whether the tandem will be stable enough with lar...
How does histology and/or molecular testing change your approach? How does the length of the disease free interval change your approach?
Assume a mild but diffuse case of lichens sclerosis with involvement of the ipsilateral breast. If node negative disease, would you recommend she unde...
This patient previously received hysterectomy with adjuvant vaginal cuff brachytherapy without pelvic RT. Colonoscopy demonstrated invasive disease, b...
How is your approach different from or similar to those who undergo surgical menopause?
How would you approach the treatment if the tumor is PDL1+?
Is there an optimal chemotherapy regimen that optimizes cure rates while minimizing side effects?
What are the expected outcomes if you were to irradiate the pelvis in someone on peritoneal dialysis?
If a patient presents with metastatic disease (by virtue of extensive PA nodal burden, mediastinal/SCV involvement, no solid organs) but received urge...
Would you offer radiation therapy? If so, what dose and fractionation would you use?
This endometrial cancer was a fortuitous finding following vaginal hysterectomy.
Do you include pembrolizumab with platinum-taxane + bevacizumab or reserve it as a second line option?
If considering systemic therapy, would you consider standard chemotherapy or use biomarker-directed therapy (e.g., imatinib if ckit+, larotrectinib/en...
How does your approach vary based on residual disease left at the time of surgery? Please specify your approach for the amount of residual disease at ...
Would you do SIB to gross nodes in the pelvis and/or inguinal region? Would you do SIB to the primary unresected tumor?
If you were to offer radiation, what dose and fractionation would you use?
When do you continue with treatment and when do you terminate the plan? What is your criteria?
(Normal oxygenation and echo)
SIBs of 55-57.5 Gy in 25 fractions are frequently mentioned with bowel volume constraints at this dose, but assuming there is no bowel nearby (e.g., b...
For a large pelvic mass that is causing abdomino-pelvic pain, can hysterectomy be considered?
Are there guidelines that dictate who in the department should be present for treatment delivery?
Do you specific renal impairment or hydronephrosis/hydroureter criteria?
In what situations would you use a neuroendocrine chemotherapy regimen over carboplatin+paclitaxel?
If the patient was interested in fertility preservation would you recommend oocyte preservation before or after hysterectomy - or not at all?
Does your decision change if a smit sleeve is being placed?
Is there a role for using pembrolizumab alone in microsatellite stable endometrial cancer if patients are unable to tolerate lenvatinib?
Are there specific clinical or social scenarios that would preclude the use of this treatment?
In the KEYNOTE-775 study, what was the proportion of patients who had a recurrence free interval ≥1 year from platinum-based cytotoxic chemotherapy...
Are there any planned trials to compare lenvatinib + pembrolizumab and platinum-based cytotoxic chemotherapy for advanced or recurrent endometrial can...
In patients <50y/o, would you a favor a surgical approach in cervical malignancies that have pre-operative borderline Sedlis criteria indications f...
Does your approach to the number of cycles vary based on plan to include radiation therapy or presence of certain histopathologic features?
Anecdotally, I have seen more serious IRAEs in patients I'm treating with this regimen than anticipated. Is there higher risk with this drug combinati...
Is there any particular reason to include or not include this in the treatment volumes?
The patient has no risk factors and would have been stage IB if it were not for the small nodule
What factors influence whether you treat an elective nodal volume vs gross nodal volume (plus a small margin) in the setting of oligometastatic or oli...
How reliable is somatic testing to detect an underlying germline predisposition?
If resected, what is your approach to adjuvant therapy?
<60y/o, grade 1 endometrioid endometrial cancer. TLH, BSO, sentinel nodes. Stage IA, focal LVSI, 20% myometrial invasion, negative sentinel nodes, ...
Would you consider additional EBRT or vaginal cuff HDR in a patient with previous tx with EBRT (45Gy) + HDR (30Gy) for a R1 resection with a radial ma...
Are there certain patient or disease related factors that would lead you to incorporate lenvatinib + pembrolizumab earlier?
What are the pros and cons of using uterine artery embolization with regard to how it may affect the efficacy of radiation (+/- chemotherapy)?
If so, do you use it for all patients or only cisplatin doses >= 70 mg/m2? What dose of mannitol do you use?
And if the tumor is MSI-H, does that alter your thoughts?
Adjuvant chemoradiation? Would you boost the positive parametrial margin? Would you also boost vaginal cuff with brachy?
How long after hysterectomy would you consider delivering adjuvant radiation therapy? Would this differ for external beam versus brachytherapy?
Are t...
Are there any criteria you use to preferentially recommend primary chemoradiation instead of primary surgery?
Do you prophylactically start all patients on B12, B-complex, and/or omega-3? If so, what dose? What about ice mittens and booties?
Considering the treatment of platinum resistant ovarian cancer as done in the AURELIA trial (Pujade-Lauraine et al., PMID 24637997).
Have you found Trendelenburg positioning helpful for situations in which small bowel falls into a high dose target volume?
Would you delay salvage surgery for a stage I primary vaginal cancer with partial response but no new disease at 3 months after radiation (EBRT + brac...
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
...
If a weekly schedule is chosen, what would be the appropriate weekly dose given that PORTEC-3 and GOG 258 used two cycles of cisplatin 50 mg/m2?
How does the presence of specific mutations affect your adjuvant treatment planning or patient counseling?
Given POLE mutation status can currently o...
Is this a clinical/radiographic or strictly pathologic diagnosis?
Specifically, what is considered the superior/top border of LUS?
Would you still take the primary to 60-70Gy?
After a diversion, would any other factors impact your recommendation (residual disease/response to chemoradiation, performance status)? Although brac...
Most interested in patient cohorts who have not demonstrated a good response to chemotherapy as measured by imaging and/or clinical/serological findin...
Is there a specific brand or formulation you prefer?
The literature supporting the use of probiotics does not standardize the type or dose of probiot...
Given data from metastatic breast cancer trials that show benefit with continuing trastuzumab despite progression.
In patients who continue to have insomnia despite diphenhydramine, benzos, and trazodone, are there other evidence based treatments that are helpful?
Assuming minimal toxicities except fatigue from long, recurrent infusions.
Do you increase EBRT or brachy dose by a certain amount based on interval?
Treat as invasive disease with concurrent chemotherapy? Any non-radiation options for large in-situ disease? If RT, would you include at least inguina...
Do you stop therapy at 2 years or continue until progression of disease?
Path significant for LVSI and MELF pattern. Post-operative CT negative for metastatic disease.
What is the impact among patients and providers?
Has your documentation been adjusted now that patients can readily review?
Would you recommend whole pelvis as well as vaginal cuff brachytherapy?
Would you perform oophorectomy of the other ovary and an appendectomy?
Do you recommend upfront diversion? Are there unique planning considerations such as the inability to use bladder filling? How do you boost? What are ...
VC brachy, pelvic RT, +/- chemo?
Does your management change if it is confined to the endometrium without myometrium invasion or if it is only ...
Presented with 8cm pelvic mass and had large omental cake + significant carcinomatosis on diagnostic lap. Biopsy ultimately resulted non-epithelial ov...
A certain cm above the superior-most involved node? A certain number of vertebral body above? To the diaphragm and include retrocrural nodes?
Apart from H&N SCC, are there times where adding an extra dose of radiation due to a tx break is appropriate? Is there a decent equatio...
How do you maintain a trusting relationship with your patients when this relapse occurs?
Assuming low risk of progression to AML and eligible for low-risk chemotherapies per hematologic/oncology.
In the absence of the ability to use IGBT, would you continue to treat the target?
Assuming the nodal assessment is minimally invasive and the patient is otherwise healthy without postoperative complications.
Is it possible that the dehiscent is radiation induced?
https://pubmed.ncbi.nlm.nih.gov/34874631/
If the tumor was excised but there is infiltration and encasement of the sciatic nerve, would you offer radiation? If numerous lines of chemotherapy h...
Consideration for localized therapy alone vs. localized therapy + systemic chemotherapy.
No parametrial involvement on MRI.
How do you decide if it may be safe to continue immunotherapy?
Would involvement of the PA nodes be an indication?
No mesenteric/small bowel/lesser sac involvement on imaging
Do you try to keep Hb> 10 or 12? Or somewhere in between?
Do you routinely recommend any dietary changes or is the evidence not convincing?
Genes such as ATM, CHEK2, PALB2, RAD51C/D, BRIP1 seem to show some potential increased risk of ovarian cancer. Should these patients under prophylacti...
EBRT vs VB? She technically meets PORTEC2, but also meets GOG99 and GOG249 (for pelvic RT) and PORTEC4. NCCN recommends for IB grade 1 vaginal brachyt...
For a young patient that underwent fertility sparing surgery for immature teratoma of the ovary, would you treat until tumor markers normalize even if...
Is there any indication for ENI in early stage disease or in advanced stages, without pathologic confirmation or PET positivity or CT size criteria?
Initial treatment of the primary invasive Paget's disease of the vulva that was metastatic to inguinal lymph node included resection and chemoradiatio...
The patient was initially observed after radical hysterectomy due to young age, FIGO IA grade 2 disease.
The patient had isolated, biopsy-proven vagi...
Do you allow patients with breast cancer on tamoxifen to use black cohosh?
Patient is 38yo, has a history of narcotic abuse, and may have an undiagnosed personality disorder.
Is there any role for completion surgery and/or RT in addition to chemotherapy?
12cm mass on ovary s/p TH/USO and preservation of grossly normal cont...
If not, how often do you repeat pelvic imaging?
Is the QuadShot a possible option?
If yes, what would be your target volume for this exceedingly rare histology for this location?
In women receiving HDR intracavitary brachytherapy to treat the vaginal cuff, how do you overcome the challenge of excess lateral vaginal tissue ("dog...
Could EBRT lead to rupture of the cyst?
This patient has pulmonary nodules that are too small to characterize.
Does ER/PR status help guide your decision?
No sarcomatous overgrowth seen.
Is anticoagulation for PE an absolute or relative contraindication to IS brachy? Would you favor placement of IVC filter prior to procedure?
For instance, in patients that have not had neoadjuvant chemotherapy
History of CDH1 mutation and prophylactic gastrectomy in 2017 - no other primary site found beyond vagina at diagnosis.
Vaginal tumor completely resp...
In follow up to @Jacqueline Casillas presentation at ASCO 2021 regarding models of survivorship care delivery for AYA patients.
How do you manage the initial event, including length of steroid taper and the role of pancreatic enzyme monitoring?
What is your experience of subse...
Previously received pelvic EBRT and intracavitary brachytherapy. IORT was administered to the node-positive side wall at the time of exenteration.
Initially treated with definitive chemoRT but recurred with distant mets. Completed 6 cycles carb/tax/bev with minimal toxicity. Excellent performance...
Excellent KPS and long disease free interval from initial diagnosis. Initial recurrence 3-4cm at level of renal vessels and down to 1.3cm after chemo.
PET- CT before surgery visualised a tumor localised to the uterus and a PET positive 3 cm enlarged node at L3 level.
Final path: endometroid FI...
Lung is biopsy proven met cervix, SBRT is planned.
Patient did not previously receive para-aortic radiation. Considering RT vs RT + chemo vs chemo alone
Are there any effective non-pharm or pharm interventions?
Recurrence was 2cm and PET confirmed local. Excision with positive margins. Current plan for salvage whole pelvic RT and vaginal cuff brachytherapy +/...
s/p optimal debulking.
If this was an early-stage cancer would it change your adjuvant therapy recommendations?
If confirmed neuroendocrine and PD-L1 pending, how would you treat?
In patient with PD SCCA 15mm transverse; 5/20mm invasion; LVSI focally present; margins negative; 0/15 Left pelvic and 0/14 right pe...
Recurrence picked up incidentally on CT. No germ line mutations, somatic tumor testing of node resulted negative.
PET confirmed isolated recurrence
Planning carboplatin/taxol/trastuzumab. Cervical stromal invasion on path. Looking for pelvic vs brachy and timing with chemotherapy.
If a patient has limited surgical options and a well defined lesion, would SBRT be reasonable?
What is your strategy to prevent and treat constipation in patients initiating or receiving opioids?
What non-pharmacological interventions do you recommend? Do you routinely prescribe prophylactic laxatives to patients initiating opioids? How do you ...
What dose and technique do you use and how do you integrate the subsequent definitive treatment plan?
Would your counseling change if she reported a history of unplanned pregnancy? Is there any wording or waiver you might be able to use warning her of ...
The recently released STARS phase 3 RCT found improved DFS, decreased distant recurrence, with reduced toxicities for chemotherapy (cisplatin + taxol)...
30cm tumor, intraoperative rupture, all abdomino-pelvic surfaces and structures appeared free of disease.
Primary, R0 debulking in 2019, stage IA. Low volume recurrence, now again optimally cytoreduced.
Initial diagnosis was 15+ years ago
Despite the LACC trial, this year's SGO had many posters and discussions around MIS for early cervical cancer.
If you offer MIS, what are the key ele...
For a patient with a very locally advanced cervical cancer, what is your upper/superior limit of considering para-aortic lymph nodes to be "pelvic" or...
To avoid disfiguring surgery, would you consider treating a 2 cm well lateralized tumor without surgery? If so, would you recommend concurrent chemoth...
Does your practice vary based on risk status (low vs high risk) or specific mutation status (BRCA+ vs HRD+) given PAOLA subset analyses?
How long is too long to wait for recovery? Is there a role for pre-procedure platelet transfusion and/or alternatives to epidural anesthesia?
Would you have reservations in treating patients with breast, GI, or pelvic malignancies with radiation alone or concurrent chemoradiation?
I am considering every 6 week pembrolizumab dosing in patients >70 years old in whom I want to reduce clinic visits for, especially in the context ...
What specific platforms for determining somatic BRCA and HRD status do you use for a patient who does not carry a germline BRCA mutation?
Would you offer VBT alone in a completely resected vaginal cuff recurrence that is grade, recurrent stage IA endometrial cancer, is all staging imagin...
Margins negative, no LVSI, PET/CT negative.
If yes, what type of testing platform would you use?
Are there clinical factors which help stratify? Does your practice vary based on mutation status (BRCA+ vs HRD+?)
Does germline vs somatic BRCA mutation affect your decision?
How many cycles do you prefer before and after? How long do you tend to wait before starting radiation after initial chemo and after radiation to resu...
Is MDS/AML risk increased with longer duration of therapy? Does your approach differ for patients who are BRCA+/HRD vs wild type/HRP?
How would you factor in a patient with profound thrombocytopenia?
Paraaortic nodes positive to left renal vein
Primary R0 debulking in 2018 followed by Carbo/Tax for 6 cycles, and single agent Bevacizumab followed by Letrozole, now again with NGR
6.6cm tumor, 15% MI
Tumor felt to be technically unresectable due to extensive cervical/parametrial involvement.
ER/PR and HER2 testing are pending.
For instance, if you have anal canal involvement, do you cover the entire mesorectum? Any other adjacent organ invasion that would lead to modif...
Tumor traverses the myometrium to focally involve the serosa; 1/6 sentinels with ITC and the rest negative.
No hormonal or somatic tumor testing has been obtained.
Would PET-positive pelvic or paraaortic lymph nodes change this recommendation?
Specifically, are there strategies you use to 1) empower patients to participate in decision-making and 2) reassure patients who may be skeptical?
Do you use specific tools or take into account certain factors when considering treatment options for older adults?
Path significant for micropapillary features and micro-invasion
Patient has tolerated combination therapy well to date.
Pt is 73yo, Grade 1, 81% invasion, MELF like features, foci of LVSI, and 47 ITCs identified.
Pt is 69yo, tumor 1.4cm, negative LVSI, ER/PR +
Currently 7 weeks pregnant, diagnosis based on CKC
Given recent approval of niraparib (Zejula) for the maintenance treatment of adult patients with advanced epithelial ovarian, fallopian tube, or prima...
Patient is 34yo and G0 referred from surgical oncology. Laparoscopic specimens of myoma and what appeared to be adhesions were significant for maligna...
If patient meets high intermediate risk criteria, would you consider chemotherapy in addition to radiation?
Does not technically meet high intermediate risk criteria.
Is there a role for continuing beyond 24 months?
NCCN vulvar guidelines only recommends inguinal LND but GOG 37 recommended PLND when groin nodes were positive. NCCN penile guidelines also recommende...
Tolerated first line, however now with rising Beta-HCG, new mass in uterus, and pulmonary metastases.
Margins widely negative - 1cm, and full bilateral inguinofemoral lymphadenectomy performed.
ex. in a patient with pulmonary micronodules, inguinal, pelvic, PA nodes
How do you incorporate surveillance imaging for patients with ovarian cancer on maintenance therapy?
Does your strategy differ if the patient is on maintenance PARP inhibitor, bevacizumab, both, or neither?
In an elderly woman who is not felt to be a good candidate for radical surgery is split course radiation alone an option for definitive intent radiati...
If bilateral inguinal LND showed no involved nodes and primary is unresectable (FIGO IVA), can one treat only the primary w/o elective radiation to th...
The 2020 NRG endometrial and cervix contouring guideline update said the anterior margin is a straight line between the aorta and IVC. Should there be...
Patient is currently 7 weeks GA with 1.5cm visible lesion. MFM recommends 13wk CKC vs LEEP with cerclage at that time.
Would you change your approach based on platinum sensitivity or other factors?
Patient is s/p USO only, would you take her back to remove the contralateral ovary?
Disease involves the lungs diffusely and bilaterally.
If only palliative treatment is recommended, what should be the target volume (primary only? pr...
Patient is currently cycle 5/6 of carboplatin/taxol and tolerating well, has received no bevacizumab.
Margins negative. Discussion included adjuvant RT versus observation and/or repeat resection with recurrence.
In the unfortunate setting where you cannot get an underinsured patient whose policy does not cover radiotherapy started on treatment without guarante...
Do you re-test patients who test positive for COVID-19 during or prior to starting cancer treatment?
There are mixed recommendations about re-testing vs simply waiting for a quarantine period prior to resuming therapy.
Pathology with infiltrative subtype
EP vs C/T? Would you perform additional imaging, ie. PET Dotatate to evaluate for metastatic disease?
What indications do you use to consider adjuvant radiation therapy for vaginal cancer s/p resection?
Would you offer adj RT for a vaginal primary patient with paravaginal involvement s/p rad hyst w/ upper vaginectomy, BSO and inguinal node dissection?...
Would you consider adjuvant chemotherapy, radiation therapy, hormone therapy, or surveillance?
Do you use brachytherapy or external beam? What prescription / dose / regimen do you typically use? What if there is small bowel hanging into the fiel...
The patient has a history of pelvic radiation and progressed through first line carboplatin/taxol. She has had a partial response to pembro/lenvatinib...
Vulvar cancer is well differentiated. Closest margin is 6mm. LVI is identified
T1b N2c
Vaginal cancer treated 20 yrs ago described as 5 cm in length...
Patient has been treated with carbo/taxol, hormonal therapies, and trametinib to date.
Final pathology showed grade 3 spindle cell sarcoma of thee vagina involving the anterior lateral cervix 5.6cm x 4.5 x 3.4cm, <0.1cm left lateral m...
Based on recent PAOLA-1
WHO score 8, for initial beta hCG, tumor size, and failure to respond to inpatient high dose MTX therapy (given as patient originally desired fertilit...
How (if at all) does this change your counseling and willingness to add bevacizumab to a regimen?
Would you consider "neoadjuvant" hormonal therapy to shrink tumors and potentially make more amenable to complete cytoreduction at a later date?
Woul...
For example, RTOG1203 says to include "1-2 cm of tissue anterior to the S1, S2 and S3 sacral segments" but have also heard of stopped at S2 to limit r...
Particularly with IMRT when delineating volumes.
Incidental diagnosis after hysterectomy
Does your management change if the patient is a BRCA1/2 mutation carrier?
Lesion measures 2cm and PET is otherwise negative.
CPS score is pending
Would you consider SBRT or brachytherapy?
After optimizing symptoms and reversible factors, and attempting cognitive-behavioral interventions and exercise, do you recommend pharmacologic agent...
Would you offer EBRT alone or EBRT with vaginal cuff brachytherapy after surgery and chemotherapy for stage III (T3N0) carcinosarcoma of the uterus?
...
What factors affect this decision?
Patient with remote history of hysterectomy for benign disease
What dose would you consider for patients with bulkly pelvic disease and in what situations would you, if ever, dose escalate for local disease with b...
Does residual grade 1-2 neuropathy from Taxol/ carbo 10 years ago affect your recommendation?
Small bowel is usually the dose limiting OAR while planning cervical HDR brachytherapy. Having the bladder empty during treatment planning and deliver...
Literature regarding treatment of diarrhea due to Trametinib is limited and does not address safety of Lomotil.
Ie for patients who are inoperable due to comorbidities?
Would you consider this a new primary or recurrent disease?
For a patient with good response to immunotherapy (unable to receive chemotherapy due to kidney function, comorbidities) where previously avid LN have...
Does time since adjuvant cuff brachytherapy influence your radiotherapy approach, (for example 18 months vs 5 years)? Do you adjust your bladder/bowel...
HER2 positive
Since no data exists or is pending, and the two disease processes are similar, should we consider PARP inhibition in this setting? This is assumi...
E.g. a patient with progression of their primary cancer but still is testing COVID19+ over a month after infection?
https://ascopubs.org/doi/abs/10.1200/JCO.2020.38.15_suppl.6000
http://abstracts.asco.org/199/AbstView_199_180760.html
http://abstracts.asco.org/199/AbstView_199_187537.html
Does cisplatin need to be administered on the start date of radiation
What if the sentinel nodes demonstrate macrometastatic disease?
I care deeply about clinical trials but have always struggled on how to approach this topic. I would really appreciate tips from those of you who have...
If an external boost of a gyn primary is necessitated because of the target size or extensive involvement of a critical structure how would ...
How would tumor grade, presence of LVSI, and receipt of chemotherapy factor into your decision?
Keynote-146 included 9 (17%) "other adenocarcinomas," but did not specifically exclude carcinosarcoma. Carcinosarcoma was specifically excluded from K...
This has been a common practice in the community. Is there a benefit for certain patients?
Can it be prevented? How do you evaluate patients? What non-pharmacologic or pharmacologic interventions do you use for treatment?
When would you recommend SRS vs WBRT?
Does the GOG 249 abstract guide you one way or the other?
How do you counsel a pre-menopausal female with endometrioid cancer desiring definitive RT with egg harvesting and IVF for fertility preservation inst...
Obviously, patient and caregiver preferences are paramount. But, what factors do you consider? Does expanded hospice (e.g., Medicare Care Choices) inf...
Sentinel Lymph Nodes negative
What dose/fractionation would you recommend?
How would you approach a patient who is receiving chemoRT but has confirmed COVID-19 with minor symptoms, as breaking treatment for 2 weeks quarantine...
When a physical exam is important and telehealth is not a good option, should we be proactive and reschedule or should we continue to see them as sche...
No adjuvant treatment was given upfront
How do you prevent early menopause in women? Please comment on freezing of eggs, oophopexy, supine vs prone position, vaginal dialator.
Margins are negative.
Specifically, if they are to be treated similar to GI cancers that receive FOLFOX/EPIC
MRI with intravaginal gel shows no gross residual disease.
Insurance authorization for protons is pending, but if the patient cannot have protons would you treat with standard fractionation to ~70Gy or conside...
NCCN recommends brachytherapy plus or minus pelvic RT for surgically staged Grade 1, Stage II patients, but these originally staged IIB patients were ...
What fields would you cover and how much dose would you boost to the primary?
Would you consider EBRT or brachytherapy boost to the nodes? what dose would you recommend?
What field and dose would you recommend? Would you consider whole abdominal?
For the management of stage II endometrial cancer, NCCN says pelvic RT and/or vaginal brachytherapy. Do you ever add vaginal cuff boost to pelv...
If so, would you treat the whole pelvis, cuff brachytherapy, or both?
The patient had an initial partial vulvectomy and nodal dissection 6 years prior to recurrence, with no adjuvant RT offered initially due to lack of c...
Patient being treated for cervical cancer noted to have a < 1 cm posterior vaginal fornix defect with a small focus epiploclia herniating into the ...
SOLO1 trial studied stage 3/4 patients.
Would you recommend any planning techniques or dosimetric constraints in this scenario?
The limited data on MDA (minimum deviation adenocarcinoma) suggests it has a worse prognosis, but it is hard to disentangle this from stage, as it is ...
MRI and cervical biopsy are negative for cervical involvement
Would there be a substanital increase in the risk of toxicity using such a scheme?
We frequently have patients who have to travel long distance...
RP node with treatment related changes and surgical specimen from TAH/BSO no other foci of malignancy found.
In December 2018, Horn et al reported the results of a phase 3 clinical trial in the NEJM (N Engl J Med 2018; 379:2220-2229). This trial included prev...
The initial treatment did not include any adjuvant chemotherapy or radiation therapy.
Would you be more or less likely to use a cisplatin-containing regimen if a patient had previously responded to chemoradiation with concurrent cisplat...
For a patient with vaginal adhesions/stenosis, do you recommend any other therapy besides a dilator?
Would estrogen cream be helpful in this scenario?
If so, are there any lymph node cut-offs you would have in terms of lymph node number or pathological ECE before you would add contralateral RT? What ...
https://www.nejm.org/doi/full/10.1056/NEJMoa1813181
are there any positive or negative synergies from combined megestrol/RT treatment?
Should these patients be managed similar to p16 positive anal squamous cell carcinoma, and allowed six months or more for complete regression before c...
What chemotherapy and sequencing with radiation therapy would you recommend? IS surgery a component of the treatment?
Is pembrolizumab considered standard of care in the 2nd line treatment of recurrent cervical cancer?
Does the phase II KN-158 provide sufficient evidence to change management?
Should this be done at the time of recurrence or after failure of 1st line therapy for recurrence?
With the recent publication of GOG252 - does this change your management for patients with ovarian cancer who undergo primary surgery who have an opti...
What is your typical treatment depth prescribed to? What length of vaginal mucosa do you typically treat?
Do you have an SUV cutoff for physiologic activity of the ovary?
How does fertility preservation factor into your decision making?
Surgeon is not planning vulvectomy, since biopsies showed 2 mm depth of invasion.
Also tumor board felt dose to the primary site should be only about...
In a patient, with multiple small volume lesions (5-25mm), would you offer pelvic RT?
At what point would you introduce the discussion of weight management, whether for risk reduction or overall health?
Do you cover common iliac nodes (L3/L4) or keep field edge at L4/L5 to reduce bone marrow toxicity?
The NCCN recommends either systemic therapy + brachytherapy or pelvic RT + brachy or brachy alone or observation. How do you decide among these option...
The disease involving the endocervix was felt to be separate and appeared like a drop metastases
Specifically, is hyperbaric oxygen therapy (HBO) an effective treatment for refractory radiation cystitis?
Given the recent press release regarding the update on the phase 3 soft tissue sarcoma study of LARTRUVO (olaratumab) showing no benefit to the combin...
If so, what indications would you use other than Peters criteria?
What would be factors that would indicate the need to include the pelvic nodes?
Do you use a trimmed 10 mm expansion on HR-CTV? Do you also include the entire initial extent of disease? How much does your IR-CTV coverage affect yo...
Should this be the new standard of care based on the results from the recently published SOLO-1 trial?
Two new phase 2 studies this year with apatinib/oral etoposide (AEROC) and sorafenib/topotecan (TRIAS) were released, and NCCN also lists many single ...
What dose would you use?
Current NCCN guidelines suggest that vaginal brachytherapy is optional, and there may be concern for over-treatment locally given competing risk of di...
A literature search indicates that most port site recurrences are managed fairly aggressively with chemoRT or RT doses 45-66 Gy. This is understandabl...
Or do you wait for platinum resistance?
Sequentially or do you integrate the cuff brachy with the EBRT and if so what schedule, BIW, weekly, etc?
Hydrogen peroxide douches? Antibiotics? (If so, what are you covering?) When do you initiate hyperbaric oxygen? Do you find pentoxyfyline helpful? How...
When you prescribe your dose at 0.5 cm depth of the vagina? For instance, if you measure a vaginal length to be 8 cm, would you prescribe to treat 4 c...
Would organ invasion (bladder/rectum), size, feasibility of T&O, or size of nodes push you toward neoadjuvant chemotherapy?
While EBRT + brachy may be preferred, what treatment would you offer if surgery has been performed? What dose and volume of EBRT, brachytherapy, or bo...
How do you weigh this concern with the need to prophylactically treat non-involved, high risk para-aortic lymphatics?
How high would you extend your field? Would you treat differently if the patient had lower PET avid pelvic lymph nodes?
Do you use size criteria (i.e. bulky nodes over 3 cm), specific adverse histology (adenocarcinoma), or location (near small bowel), etc.
Certainly ovarian cancer will respond to carboplatin and paclitaxel and it sounds like a reasonable chemotherapy to give to a stage IV NSCLC, however ...
More recent Italian (Sozzi et al) and French data (Canlorbe et al) show associations of greater tumor size > 25-35mm with higher rates of local &am...
She has extensive colposcopic lesions at upper/mid vagina, but no palpable/visible lesions on standard pelvic exam. Pelvic MRI with 20cc US gel in vag...
PORTEC-3 assigned women with high risk stage I or stage II-III endometrial carcinoma to adjuvant external beam radiation vs adjuvant chemoradiation wi...
Is it reasonable to use single agent carboplatin for elderly patients?
Has your institution changed practice patters based on the findings of the LACC Trial (Pedro et al., SGO in 3/2018) showing worse outcomes with roboti...
NCCN guidelines mention EBRT/vaginal brachytherapy as options in addition to chemotherapy in the adjuvant setting for high grade histologies, stages 1...
If the patient is responding to external beam and likely to be converted to resectable, what brachytherapy dose/fractionation do you prescribe and wha...
Assuming no distant metastases, should this scenario be managed with "sequential" chemoradiation to the para-aortic region with an external beam boost...
For HDR brachytherapy for cervical cancer do you use the dose optimization algorithm? Is there a standard dwell time distribution that should be...
For example, assuming an excellent performance status, would you consider local radiation to the primary and metastasis in someone with a single ...
Patient had a single 3cm node s/p excisional biopsy of the one node without nodal dissection. We have done anoscopy and a thorough GYN exam...
EBRT boost only? SBRT? If you recommend interstitial brachytherapy do you place needles freehand or with a template based approach?
What have your liked or disliked about these newer applicators?
In a patient who underwent laparoscopy for endometriosis and was found to have a 1mm focus of neuroendocrine tumor, would you recommend further surger...
if so, would you favor brachytherapy alone? What dose?
What would be the appropriate treatment for grade I endometrial cancer s/p TAH/BSO but with SLNB yielding negative nodes. The uterus contained a 2cm t...
Assuming the early stage endometrial cancer was treated with TAH+BSO initially and no further treatment, what would your recommendations be for HGIL? ...
If so what dose/fractionation? This was reported here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3918530/
For women treated with IMRT, there are multiple ways to define the upper border of the field
1) contouring the PAs up to where the renal vessels exit...
She has metastatic disease beyond the pelvis (lungs).
Type II endometrial cancers made up roughly 15% of GOG 249 the study population, but seemed to be balanced between both arms.
Single institutio...
After whole pelvis radiation therapy, what would be the highest dose you would allow in a single fraction, versus the total course EQD2 for small bowe...
Would you consider this in a patient with a single omental metastasis found and no other distant spread after surgery?
For example, a patient with cervical or anal SCC who has missed many treatments due to side effects, low blood counts, hospitalizations, or non-compli...
What factors influence your decision? Does high grade histology or pathological stage play a role? If the patient received chemotherapy due to +LN, pa...
Do you add an IMRT boost with possibly vaginal brachytherapy?
What are your specific protocols for monitoring and for dosing narcotics and sedatives?
In what situations is it appropriate to offer observation (rather than VBT) to patients with stage II endometrial carcinoma who have had a radical hys...
If a patient has a gynecological cancer, how long should one wait after RT before a screening colonoscopy can be completed?
Would you approach this situation as synchronous primaries (eg. FIGO IA in both) or as a locally advanced endometrial cancer (FIGO IIIA)?
What adjuva...
Does definitive or adjuvant setting effect your planned dose? For example, for a woman with IB2 cervical cancer status post hysterectomy, who wa...
When should pelvic/inguinal lymph nodes be included?
Would you utilize IMRT to provide a boost to gross disease? If so, how would you define your treatment volumes and what dose would try to achieve? Als...
Would you still consider this high risk? If so, would you recommend pelvic radiation AND chemotherapy?
Would you add chemotherapy if there was gross residual disease, pN+ and/or ECE?
Can the classic indications for post-hysterectomy radiation (eg. "Sedlis" and "Peter's" criteria) be applied? Does the histology change radiation dose...
Is there evidence for SBRT for recurrent ovarian granulosa cell tumors?
If offering radiation therapy, would you treat extended field whole pelvis or just cover the para-aortic LNs with an involved field volume? Would your...
What are the pros and cons of completing a simple hysterectomy versus aborting surgery followed by chemoRT?
With stage I/II vaginal cancer and an excellent response to 4500cGy EBRT with <5mm residual thickness of tumor remaining, what is your dose/fractio...
Would your recommendations change based on stage? What factors would influence your decision to include presacral lymph nodes in a locally advanced en...
Does this differ if the primary is vaginal? Do you prescribe the same dose when using an intracavitary applicator for cervix cancer?
For palliation of vulvar cancer, what fractionation due you typically use. Can some of the toxicity be avoided with a shorter course of treatmen...
Prior to starting vaginal cuff brachytherapy, do you wait for a specificed period of time prior to vaginal cuff brachy after hysterectomy? Do y...
With the results of the EMBRACE protocol, how do you approach MRI planning? Do you plan with applicators in situ, or use preimplant (post EBRT) ...
Does this management depend on treatment site?
For definitive vulvar ca, is 5940 cGy the minimum acceptable dose for gross disease? 5760cGy? Or should the dose be escalated beyond 60Gy?
Can the drug continue during radiation therapy or should it be discontinued at a specified time prior to initiation of radiation?
And if so, in which situations do you offer differing doses?
For example, would you consider adjuvant chemotherapy alone to be sufficient in a patient with an isolated pelvic recurrence and positive margin after...
For example, how do you decide between applicators such as tandem and ovoid versus tandem split ring insertion for cervical brachytherapy patients?&nb...
For instance, RTOG 0418 did not allow clear cell or papillary serous histologies, but subsequent trials that allow IMRT have (GOG 0249, 0258, RTOG 120...
Interstitial needles can result in hot spots in the bladder, but how well tolerated is that? On the other hand, intracavitary applicators usually don'...
For example, in an otherwise intermediate risk localized endometrial cancer (Grade 2, FIGO IB)?
What clinicopathologic features do you typically consider?
In the setting of a negative lymph node sampling, would you treat a full pelvis or mini-pelvis to compensate for lack of the appropriate surgery? Is a...
In patients who don't meet traditional criteria for adjuvant chemoradiation from Peters (GOG 109) and < 2 high risk factors from Rotman (GOG 92) fo...
If the post-operative simulation films reveal a significant lymphocele secondary to pelvic lymph node sampling, is it imperative that the entire lymph...
The gyn oncs at my institution sometimes will not perform lymphadenectomy if biopsy indicates low risk disease. Would LVSI as sole adverse risk factor...
Do you use SIB or sequential approach? Do size of lymph nodes influence your dose or decision?
What exactly do you contour and what is your dose constraint to that volume?
Does using something like a vienna applicator allow you to avoid dose escalation with more external beam? How do you recommend doing a classic pa...
Some classic references recommend the coverage of the entirety of the sacrum but the volume delineation guidelines for both seem to only cover the mos...
The patient failed previous excisions and medical therapy and is no longer a surgical candidate.
Does hydroureter and leg edema alter your opinion?
Brachytherapy, EBRT or both and what is the best dose?
How should we counsel young women who are receiving treatment for GI/GYN malignancies?
Do you plan every fraction, every other fraction, or use one plan for the whole treatment?
The most recent ABS guidelines don't discuss a dose constraint for the small bowel.
What schedule is best for preventing fibrosis and for patient compliance?
Does your strategy change if bladder invasion is present?
Do you treat PAs if pelvic nodes are positive? If common iliacs are involved? Only if there are positive PA nodes?
Do the urethral constraints used in prostate brachytherapy apply to women undergoing gyn brachy?
Papers discussed in this category
Gynecologic oncology, 2004-03
Int. J. Radiat. Oncol. Biol. Phys., 2011-11-15
Lancet, 2010-03-06
Obstet Gynecol, 1980-10-01
Lancet (London, England), 2009-01-10
Gynecol Oncol, 2019 Aug 16
JAMA,
The New England journal of medicine, 2019-06-13
Int. J. Radiat. Oncol. Biol. Phys., 2005-08-01
Int. J. Radiat. Oncol. Biol. Phys., 1990-02-01
Brachytherapy, 2013
International journal of radiation oncology, biology, physics, 2011-02-01
Int J Radiat Oncol Biol Phys, 2013 Jul 9
Gynecologic oncology, 2003-12
JAMA Netw Open, 2021 Apr 01
Int. J. Radiat. Oncol. Biol. Phys., 2014-05-01
Brachytherapy, 2015
Gynecologic oncology, 2007-11
Eur. J. Cancer, 2008 Apr 02
J Clin Oncol,
Gynecologic oncology, 2018-10
Gynecologic oncology, 2014-11
International journal of radiation oncology, biology, physics, 2018-08-01
Brachytherapy, 2019 Sep - Oct
Gynecologic oncology, 2009-10
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2006-01-01
Gynecologic oncology, 2013-10
Gynecologic oncology, 2013-01
Eur. J. Cancer, 2010 Jul 07
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-07-20
American journal of clinical oncology, 2015-06
Curr Urol Rep, 2018 Apr 13
Urology, 2016 Apr 25
Urology, 2005-04
The Journal of urology, 1999-02
Urol. Int., 2012 Jul 10
Gynecologic oncology, 2014-12
Gynecologic oncology, 2013-08
J Clin Oncol, 2012 May 10
Ann. Oncol., 2011-02-01
Gynecologic oncology, 2010-03
Int. J. Radiat. Oncol. Biol. Phys., 2012 Aug 14
International journal of radiation oncology, biology, physics, 1994-07-30
Obstet Gynecol, 2009-09-01
J Gynecol Oncol, 2012 Jul 02
Radiother Oncol, 2015 24
Brachytherapy, 2012
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2011-07
The Lancet. Oncology, 2017-03
Gynecol. Oncol., 2008-11-01
Eur. J. Cancer, 2016-09-01
Gynecologic oncology, 2017-11
Brachytherapy, 2019 Apr 17
Lancet Oncol., 2019 Jul 22
Gynecol Oncol, 2019 Sep
Gynecologic oncology, 2004-04
American journal of obstetrics and gynecology, 2010-10
Obstetrics and gynecology, 1988-01
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2014-11
Gynecologic oncology, 2015-06
International journal of radiation oncology, biology, physics, 2017-03-01
Gynecologic oncology, 2006-10
Gynecologic oncology, 2009-03
Br. J. Cancer, 2006-08-07
Gynecol. Oncol., 2009-07-01
Medicine (Baltimore), 2015-04-01
The Lancet. Oncology, 2017-09
Technol Cancer Res Treat, 2012 May 07
Cancer Nurs, 2017-04-21
American journal of clinical oncology, 2018-08
Gynecologic oncology, 2014-12
International journal of radiation oncology, biology, physics, 2005-12-01
Cancer, 1987-10-15
Gynecologic oncology, 2015-09
Brachytherapy, 2016 Nov - Dec
Radiother Oncol, 2016-09-01
International journal of radiation oncology, biology, physics, 2014-03-15
International journal of radiation oncology, biology, physics, 2013-04-01
International journal of radiation oncology, biology, physics, 2013-09-01
Eur. J. Obstet. Gynecol. Reprod. Biol., 2015 Aug 22
Cancer Res Treat, 2014 Jan 15
Gynecologic oncology, 2017-11
Curr Oncol Rep,
Adv Anat Pathol,
International journal of radiation oncology, biology, physics, 2005-05-01
International journal of radiation oncology, biology, physics, 1992
Radiother Oncol, 2016 Apr 29
Gynecologic oncology, 2014-05
N Engl J Med, 2016 Feb 25
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-06-01
The New England journal of medicine, 2011-12-29
N Engl J Med, 2011 Dec 29
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-09-10
International journal of radiation oncology, biology, physics, 2014-12-01
Practical radiation oncology, 2015
Curr Oncol Rep,
Cochrane Database Syst Rev,
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2012-06-10
Lancet Oncol, 2017 Jun
Lancet (London, England), 2017-10-28
The New England journal of medicine, 2016-12-01
The New England journal of medicine, 2012-04-12
J. Clin. Oncol.,
J Clin Oncol, 2014 May 1
Int J Gynecol Cancer, 2018 Mar
Br. J. Cancer,
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2015-02
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2014-10
Cochrane Database Syst Rev, 2010 Sep 08
Practical radiation oncology, 2017
Gynecologic oncology, 2018-08
The New England journal of medicine, 2018-12-27
Gynecologic oncology, 2019-06
International journal of radiation oncology, biology, physics, 2017-04-01
International journal of radiation oncology, biology, physics, 2019-05-01
Cochrane Database Syst Rev, 2012 May 16
Int. J. Gynecol. Cancer,
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-07-10
Int J Clin Exp Med, 2015 Sep 15
Pathol. Int.,
Oncotarget,
Semin Radiat Oncol, 2004-01-01
Practical radiation oncology, 2017
Seminars in radiation oncology, 2019-04
International journal of radiation oncology, biology, physics, 1994-06-15
International journal of radiation oncology, biology, physics, 2010-12-01
Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2010-06
Lung cancer (Amsterdam, Netherlands), 2021 Jan 30
International journal of radiation oncology, biology, physics, 2006-08-01
Gynecologic oncology, 2005-11
Clinical cancer research : an official journal of the American Association for Cancer Research, 2015-12-15
N. Engl. J. Med., 2019 Sep 28
N Engl J Med, 2019 Dec 19
Science (New York, N.Y.), 2017-07-28
The New England journal of medicine, 2018-05-31
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-12-20
Gynecol Oncol, 2017 Aug
J Gynecol Oncol, 2015 Nov 23
Int J Gynaecol Obstet,
Int J Womens Health, 2017 May 02
The New England journal of medicine, 2006-01-05
Lancet Oncol, 2013 Sep
J. Clin. Oncol., 2019 Apr 19
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-01-01
Lancet Oncol., 2014-06-01
Clinical cancer research : an official journal of the American Association for Cancer Research, 2017-02-01
Ann Surg Oncol, 2014 Aug
Cancer,
American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting, 2018-05-23
Acta Oncol, 2017 Apr 21
Lancet Oncol., 2017 Sep 04
Lancet Oncol., 2012 Sep 04
Radiat Oncol, 2015 Feb 22
Obstet Gynecol,
Cancer management and research, 2017
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-06-10
Annals of surgical oncology, 2016-05
Gynecologic oncology, 2018-12
Br. J. Cancer, 2009 Feb 17
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2011-05
Obstet Gynecol,
Gynecologic oncology, 2003-07
Obstetrics and gynecology, 2013-09
Lancet Oncol.,
Gynecol. Oncol., 2005 Dec 20
Int J Gynecol Cancer,
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-04-01
Gynecol. Oncol., 2017 Jul 30
Gynecologic oncology, 1999-05
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2000-04
Lancet,
Gynecol. Oncol., 2005 Nov 21
Lancet Oncol., 2020 Mar 03
Lancet, 2020 Feb 07
Lancet Oncol., 2020 Feb 14
Ann. Oncol., 2020 Mar 26
Gynecol. Oncol., 2015 Sep 30
Current treatment options in oncology, 2018-11-15
Gynecol. Oncol., 2019 Oct 17
J Oncol Pharm Pract, 2020 Jan 06
Gynecol. Oncol.,
Gynecologic oncology, 2007-05
Gynecol Oncol Rep, 2016 Dec 18
Gynecol Oncol,
BMC Cancer, 2019 Mar 11
Clin Cancer Res, 2017 Sep 27
Oncogene, 2020 Mar 02
The Journal of reproductive medicine, 2012
Gynecologic oncology, 2007-03
Int J Gynaecol Obstet,
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2000-01
Lancet, 2019 Nov 29
Lancet Oncol., 2014 Feb 28
Lancet,
Brachytherapy, 2015
J Clin Oncol, 2020 Feb 10
Gynecologic oncology, 2009-08
Lancet Oncol.,
Br. J. Cancer, 2018 Oct 24
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2011-04-10
Cancer journal (Sudbury, Mass.), 2007
The journal of supportive oncology, 2003
J Clin Oncol,
Breast Cancer (Dove Med Press), 2017 Jan 23
J. Clin. Oncol., 2011 Mar 28
BMC Cancer, 2017 Apr 28
Clinical cancer research : an official journal of the American Association for Cancer Research, 2018-02-15
N Engl J Med, 2019 Dec 19
J Clin Oncol, 2020 Apr 10
Int. J. Radiat. Oncol. Biol. Phys., 2015 Jan 30
Lancet Oncol., 2018 Feb 12
Gynecol. Oncol., 2018 Aug 03
Int J Gynecol Cancer, 2020 Dec 18
European journal of cancer (Oxford, England : 1990), 2012-07
Gynecologic oncology, 2011-07
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2003-09-15
Clin Transl Radiat Oncol, 2018 Jan 11
N. Engl. J. Med.,
Nature, 2013-05-02
Gynecologic oncology, 2019-09
F1000Res, 2019 Jun 12
AJNR. American journal of neuroradiology, 1996-02
Journal of robotic surgery, 2019-02
Am. J. Obstet. Gynecol., 2015 Oct 31
Obstet Gynecol,
Lancet, 2019 Apr 11
Gynecologic oncology, 2001-10
Int. J. Gynecol. Pathol.,
The New England journal of medicine, 2012-07-12
Gynecologic oncology, 2018-12
Gynecol. Oncol., 2019 Sep 26
N. Engl. J. Med.,
Gynecologic oncology, 2017-08
Am J Obstet Gynecol, 2016 Nov 18
Eur J Cancer, 2019 Jun 07
J Clin Med, 2020 Nov 28
Int J Gynecol Cancer, 2019 Dec 18
Gynecol Oncol, 2019 Jul 22
JAMA oncology, 2016-11-01
American journal of obstetrics and gynecology, 2011-08
Journal of the National Cancer Institute. Monographs, 2005
Pediatric blood & cancer, 2018-09
Obstet Gynecol,
Gynecologic oncology, 2015-12
The American journal of surgical pathology, 2015-04
The American journal of surgical pathology, 2006-02
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2013-11
Gynecologic oncology, 2017-07
J Ovarian Res, 2019 May 25
Oncologist, 2019 May
Am. J. Surg. Pathol.,
Int J Gynaecol Obstet, 2013 Oct 22
Ann Oncol,
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2013-09-01
Journal of the National Cancer Institute, 2013-08-21
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2010-02
Gynecologic oncology, 2013-04
J Dermatol Case Rep,
Gynecologic oncology, 2014-01
Cancer, 2000-04-15
Lancet Oncol.,
Lancet, 2008 Dec 16
J. Natl. Cancer Inst., 2008 Nov 25
Ann. Rheum. Dis., 2019 Sep 20
Gynecologic oncology, 2012-06
Gynecologic oncology, 2017-01
, 2007 Jul 06
,
Gynecol Oncol, 2017 Apr 05
PLoS One, 2017 Sep 05
Oncology, 2016 Oct 27
Gynecol Oncol, 2013 Dec 09
Ann Surg Oncol, 2013 Sep 20
Gynecol Oncol, 2014 Sep 16
Arch Gynecol Obstet, 2016 Dec 03
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2019-01
, 2020 Sep 06
Gynecologic oncology, 2004-04
J Obstet Gynaecol Res, 2019 Sep 09
The New England journal of medicine, 2018-11-15
Gynecologic oncology, 2019-04
J Gynecol Oncol,
Gynecol Oncol, 2020 Aug 15
The Lancet. Oncology, 2017-01
The Lancet. Oncology, 2019-05
Blood, 2008-05-15
The New England journal of medicine, 2019-02-21
J Thromb Haemost, 2019 Jul 28
N Engl J Med, 2018 Dec 04
Gynecologic oncology, 2009-10
Am J Obstet Gynecol, 2017 Dec 06
Lancet,
Journal of minimally invasive gynecology, 2016-02-01
Am J Obstet Gynecol, 2020 Jul 18
International journal of radiation oncology, biology, physics, 2004-03-01
Gynecologic oncology, 2015-11
Gynecol Oncol, 2020 May 29
Technology in cancer research & treatment, 2008-10
Obstet Gynecol,
JAMA,
Cancer Prev Res (Phila), 2019 Aug 16
Cancer, 2017-03-01
Lancet Oncol, 2019 Mar 25
Gynecologic oncology, 2007-06
Int J Gynecol Cancer,
Journal of the National Comprehensive Cancer Network : JNCCN, 2016-09
Human pathology, 2000-05
Eur J Cancer, 2013 May
Virchows Arch, 2016 Dec 27
Gynecol Oncol, 2015 Jul 29
Oncologist, 2012 Sep 28
Int J Cancer,
J Clin Oncol, 2015 Sep 28
Gynecol Oncol, 2020 Jan 20
Gynecol Oncol, 2011 Sep 13
International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists, 2015-01
Am J Surg Pathol,
International journal of radiation oncology, biology, physics, 1991-07
Cancer,
The New England journal of medicine, 2018-11-01
Breast J, 2018 Apr 23
Am J Mens Health, 2020 Nov-Dec
Clin Oncol (R Coll Radiol), 2021 Aug 13
J Cosmet Dermatol, 2022 Oct 07
Gynecologic oncology, 2017-04
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2019-01-23
Ann Oncol,
Gynecol Oncol, 2018 May 24
Int J Gynecol Cancer,
Gynecologic oncology, 2008-03
Obstetrics and gynecology, 1986-12
Gynecol Oncol, 2020 Oct 13
J Obstet Gynaecol Can,
Int J Gynecol Cancer,
J Low Genit Tract Dis,
Gynecol Oncol Rep, 2020 Jan 30
World J Surg Oncol, 2017 Jan 10
The New England journal of medicine, 2018-07-12
Breast J, 2019 Jul 04
Gynecologic oncology, 2012-10
Practical radiation oncology, 2019
BMC Cancer, 2018 May 04
Lancet Oncol, 2021 Mar 18
Lancet Oncol, 2015 Jun 23
Cancer, 2014-02-01
Tumori, 2016 May 09
J Gynecol Oncol,
International journal of radiation oncology, biology, physics, 2008-11-15
Practical radiation oncology, 2017
Practical radiation oncology, 2018
Radiother Oncol, 2020 Oct 14
Brachytherapy, 2019
Radiother Oncol, 2020 Nov 05
The New England journal of medicine, 1999-04-15
Ann Oncol, 2012 Feb 21
JAMA Oncol,
Ecancermedicalscience, 2019 Aug 06
Gynecol Oncol, 2019 Jun 10
Gynecol Oncol, 2020 Jan 15
Gynecol Oncol, 2016 Oct 10
J Obstet Gynaecol, 2017 Aug 07
Lancet (London, England), 2017-10-07
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-06-10
J Clin Oncol, 2019 Nov 04
Lancet Oncol, 2021 Apr 09
Gynecologic oncology, 2016-01
Gynecol Oncol, 2020 Jul 9
Gynecol Oncol, 2020 Jul 25
The New England journal of medicine, 2016-07-14
Practical radiation oncology, 2021 Sep-Oct
Palliative medicine, 2022 Mar 31
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2023 Mar 28
Pract Radiat Oncol, 2022 Oct 22
Brachytherapy, 2021 Mar 26
Int J Gynecol Cancer, 2019 Jan 04
Gynecologic oncology, 1998-08
EMBO Mol Med, 2020 Apr 29
J Oncol, 2020 Jun 24
Journal for immunotherapy of cancer, 2017-11-21
J Immunother Cancer, 2021 Feb
J Natl Compr Canc Netw,
Ann Oncol,
J Immunother Cancer,
J Immunother Cancer,
J Clin Oncol, 2021 Dec 20
J Natl Compr Canc Netw,
The American journal of surgical pathology, 2017-01
Histopathology, 2011 Mar 25
J Minim Invasive Gynecol, 2021 Feb 08
Gynecologic oncology, 2019-06
Gynecol Oncol, 2021 Mar 05
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2004-08-01
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-10-01
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1985-08
Cancer, 1981-08-15
Brachytherapy, 2020 Dec 29
Brachytherapy, 2002
Ann Oncol, 2021 Mar 18
Clin Transl Radiat Oncol, 2020 Apr 16
Gynecologic oncology, 2019-04
Gynecol Oncol, 2017 Jul 06
Cochrane Database Syst Rev, 2011 Jun 15
Gynecologic oncology, 2014-05
International journal of radiation oncology, biology, physics, 2017-12-01
Gynecologic oncology, 2019-03
Int J Gynecol Cancer,
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2014-11
J Clin Oncol, 2020 Jul 14
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-06-20
J Clin Oncol, 2019 Dec 19
Ann Oncol,
Gynecol Oncol, 2021 Jun 17
Ann Surg, 2014 Apr
Gynecol Oncol, 2020 Nov 28
The Lancet. Oncology, 2014-02
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2004-06-01
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2004
Arch Gynecol Obstet, 2009 Mar 21
Strahlenther Onkol, 2011 Nov 17
Gynecol Oncol Res Pract, 2016 Jun 17
Indian J Med Paediatr Oncol,
J Clin Oncol, 2020 Sep 29
Brachytherapy, 2012
Pract Radiat Oncol, 2019 Nov
Cancers (Basel), 2021 Mar 11
Journal of the National Comprehensive Cancer Network : JNCCN, 2006-05
Radiology, 2018-04
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2019-04
Gynecol Oncol, 2021 Jul 03
Gynecol Oncol, 2017 Sep 24
JAMA oncology, 2019-03-01
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2001
Int J Gynecol Cancer, 2020 Aug 04
Surgical neurology international, 2017
Eur J Gynaecol Oncol,
Radiother Oncol, 2016 Sep
N Engl J Med,
Gynecol Oncol, 2021 Oct 20
Lancet Oncol, 2021 Mar 08
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-03-10
J Clin Oncol, 2020 Mar 13
Obstet Gynecol,
Vaccines (Basel), 2021 Apr 21
Vaccine, 2020 Aug 04
N Engl J Med, 2021 Sep 18
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2011-10
Journal of oncology practice, 2019-01
Support Care Cancer, 2021 Aug 16
Arthritis Rheumatol, 2021 Apr 01
N Engl J Med, 2022 Jan 19
Gynecol Oncol, 2020 Nov 05
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2017-03
Cancer Cell, 2020 Oct 08
J Gen Intern Med, 2021 Feb 02
JAMA Netw Open, 2020 Jun 01
Practical radiation oncology, 2019-03
Cancer chemotherapy and pharmacology, 2003-07
J Oncol Pharm Pract, 2009 Sep 16
Cancer Treat Rep,
Ann Pharmacother, 2012 Jan 31
International journal of radiation oncology, biology, physics, 2013-01-01
Cancer, 2009-05-15
Gynecologic oncology, 2018-05
Virchows Arch,
British journal of cancer, 2013-04-02
N Engl J Med,
Nat Commun, 2021 May 03
Blood Adv, 2017 Jun 22
Cancer medicine, 2018-06
Gynecologic oncology, 2015-03
Gynecologic oncology, 1999-02
Gynecol Oncol, 2017 May 19
N Engl J Med, 2009 Jun 10
Cancer Res, 2020 Jul 08
JAMA, 2014-09-24
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2008
Eur J Obstet Gynecol Reprod Biol, 2021 Nov 16
International journal of radiation oncology, biology, physics, 2018-09-01
Eur J Surg Oncol, 2012 Jun 14
J Clin Oncol, 2022 Jun 06
Journal of hospital medicine, 2018-08-01
Front Oncol, 2022 Mar 09
BMJ Support Palliat Care, 2022 Jul 08
Nutr Cancer, 2019 Oct 12
Semin Radiat Oncol,
Gynecologic oncology, 2017-02
Lancet Oncol, 2014 Sep 28
Lancet Oncol, 2012 Nov 16
Lancet Oncol,
Acta oncologica (Stockholm, Sweden), 2008
Advances in radiation oncology, 2017
Radiat Oncol, 2015 Oct 27
Gynecologic oncology, 2011-09
N Engl J Med, 2019 02 28
J Gynecol Oncol, 2021 05
Cancer, 2019 Dec 15
J Gynecol Oncol, 2020 Sep
Front Oncol, 2021 Sep 06
Jpn J Clin Oncol, 2021 Mar 03
N Engl J Med, 2019 03 28
Cancer, 2000 Jun 01
J Immunother Cancer,
Arthritis care & research, 2018-10
Gynecologic oncology, 1994-04
J Clin Oncol, 2022 Mar 20
Crit Rev Oncol Hematol, 2018 Dec 24
PLoS One, 2017 Jan 26
Gynecol Oncol Res Pract, 2018 Aug 18
Breast Care (Basel), 2020 Oct 28
Clin Cancer Res, 2020 Jun 29
JCO Glob Oncol,
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-08-01
The Lancet. Oncology, 2015-11
N Engl J Med, 2021 Feb 13
N Engl J Med, 2015 Apr 19
Gynecol Oncol, 2021 May 03
Gynecol Oncol, 2019 Oct
Int J Gynecol Cancer, 2021 Mar 26
Future Sci OA, 2020 Aug 03
Cancer Treat Res Commun, 2022 Jul 01
Trends Immunol, 2021 Mar 10
Gastroenterology, 1993-06
Gastroenterology, 1991 Jul
Z Naturforsch C J Biosci, 2002 Mar-Apr
Immunopharmacol Immunotoxicol, 2003 Nov
Exp Toxicol Pathol, 2002 Feb
Biochem Biophys Res Commun, 1999 Sep 24
Ital J Gastroenterol Hepatol, 1998 Dec
Chem Biol Interact, 2001 Dec 21
J Minim Invasive Gynecol,
Brachytherapy, 2015
Cochrane Database Syst Rev, 2016 Jun 09
BMC Cancer, 2021 Oct 18
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2006-02-01
Obstet Gynecol, 1998 Oct
Acta Oncol, 2019 Apr 08
Brachytherapy, 2021 Dec 31
Haematologica, 2019 Jan 03
Gynecol Oncol, 2022 Oct 15
Am J Surg Pathol, 2015 Nov
Eur J Surg Oncol, 2022 Mar 25
Gynecologic oncology, 1992-11
Cancer, 1998-03-15
Cancer, 1998-11-15
Cancer, 2004-03-01
Lancet Oncol, 2012 Mar
Cancer, 1996 Jul 15
Gynecol Oncol, 2001 Apr
J Clin Oncol, 2001 May 15
J Clin Oncol, 2007 Jul 10
Gynecologic oncology, 2003-06
American journal of obstetrics and gynecology, 2007-11
BMC Cancer, 2021 Oct 11
Gynecol Oncol, 2019 Jan 29
Int J Gynecol Cancer, 2018 Jan
BMB Rep, 2022 Sep
J Gynecol Oncol, 2019 Sep 17
Eur Heart J, 2022 Nov 01
JACC CardioOncol, 2022 Dec 20
Pediatric blood & cancer, 2018-02
Int J Radiat Oncol Biol Phys, 2021 Mar 15
J Immunother Cancer, 2022 Jan
J Clin Oncol, 2022 Jan 06
Journal of palliative medicine, 2012-11
Nature reviews. Clinical oncology, 2016-03
Int J Gynecol Cancer, 2022 Dec 20
J Clin Oncol, 2020 Aug 04
Int J Gynecol Cancer, 2020 Oct 12
Int J Gynecol Cancer, 2021 Jun
J Contemp Brachytherapy, 2020 Feb 28
Anticancer Res, 2016 Jan
Gynecol Oncol, 2021 Nov 16
Gynecol Oncol, 2019 May 18
Gynecol Oncol, 2022 Nov 15
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2006-03-01
Clinical Medicine Insights. Oncology, 2022 Jun 24
Gynecol Oncol, 2022 Apr 22
Int J Gynecol Pathol, 2003 Jul
Arch Gynecol Obstet, 1988
Int J Gynecol Cancer, 2018 May
Medicine (Baltimore), 2017 May
Turk J Med Sci, 2019 Oct 24
Brachytherapy, 2022 Nov 03
N Engl J Med, 2023 Mar 27
N Engl J Med, 2023 Mar 27
Int J Gynecol Cancer, 2021 Sep 07
Journal of clinical oncology : Official Journal of the American Society of Clinical Oncology, 2023 Oct 21
Int J Gynecol Pathol, 2021 Jul 13
Br J Cancer, 2018 Oct 25
Int J Radiat Oncol Biol Phys, 2023 Mar 08
Gynecol Oncol, 2020 Jul 25
Translational cancer research, 2021 May
Lancet (London, England), 2023 Oct 20
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2023 Oct 23
Eur Heart J, 2022 Jan 31
J Am Heart Assoc, 2020 Jan 21
Circulation, 2020 Jun 15
Gynecologic oncology, 2014-03
Journal of the National Cancer Institute, 2016-06
Pediatrics, 2014 Feb 02
N. Engl. J. Med.,
The Journal of urology, 2018-12
N. Engl. J. Med.,
Lancet Oncol., 2014 Feb 18
NEJM Evidence, 2022 Jun 1
Br J Cancer, 2014 Apr 15
Cancer, 2011-06-15
Eur J Cancer, 2017 Nov 28
N. Engl. J. Med., 2019 Sep 28
Lancet Oncol, 2021 Jan 18
J Clin Oncol, 2021 Apr 19
J Clin Oncol, 2003 Jul 01
JAMA, 2019 Apr 16
Head Neck, 2016 Mar 29
The Lancet. Oncology, 2017-05
Gynecol Oncol Rep, 2021 Jun 09
J Obstet Gynaecol Res, 2019 Mar 06
The Lancet. Oncology, 2012-04
Cell reports. Medicine, 2022 Mar 15
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2005 Nov 11
Cancer causes & control : CCC, 2017 Mar 15
International journal of cancer, 2011 Apr 04
Frontiers in oncology, 2021 Jun 03
The New England journal of medicine, 2023 Dec 07
Pract Radiat Oncol, 2022 Mar 04
J Clin Oncol, 2023 Jan 30
The lancet. Diabetes & endocrinology, 2019 Aug 22
J Immunother Cancer, 2022 Mar
Gynecologic oncology, 2021 Apr 16
Annals of oncology : official journal of the European Society for Medical Oncology, 2023 May 19
JAMA Oncol,
Aging, 2009-12-31
Cell cycle (Georgetown, Tex.), 2010-11-15
BMC cancer, 2016-06-10
BMC Cancer, 2015 Oct 05
BMC Cancer, 2018 Apr 27
Int J Radiat Oncol Biol Phys, 2020 Jun 30
Contemporary clinical trials, 2017-02
Brachytherapy, 2021 Jan 21
Journal of gynecologic oncology, 2020 Nov
Journal of the National Cancer Institute, 2018-01-01
JAMA oncology, 2021 May 01
Antioxidants & redox signaling, 2020 Aug 07
Journal of experimental & clinical cancer research : CR, 2020 Oct 07
BMJ (Clinical research ed.), 2000 Nov 04
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2023 Jul 24
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2022 Sep 09
Obstetrics and gynecology, 2017-06
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2020 Feb 12
JCO oncology practice, 2021 Apr 29
Gynecologic oncology, 2023 Oct 11
Gynecol Oncol, 2021 Sep
Clinical oncology (Royal College of Radiologists (Great Britain)), 2019 Aug 08
Gynecologic oncology, 2021 Jan 23
Menopause (New York, N.Y.), 2017-05
Int J Gynecol Cancer, 2020 Apr
Obstetrics and gynecology, 2002 Apr
Rheumatology (Sunnyvale, Calif.), 2015 May 07
Annals of the rheumatic diseases, 2013 Jul 10
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2022 Mar
Advances in radiation oncology, 2022 Oct 25
Practical radiation oncology, 2023 Oct 22
European journal of cancer (Oxford, England : 1990), 2015 Jun 03
Gynecologic oncology, 2020 Sep 24
International journal of radiation oncology, biology, physics, 2018 Apr 04
Brachytherapy, 2022 Oct 17
Journal of applied clinical medical physics, 2007-09-17
International journal of radiation oncology, biology, physics, 2023 Jan 12
The Lancet. Oncology, 2023 Dec
The Lancet. Oncology, 2021 Apr
International journal of radiation oncology, biology, physics, 2024 Oct 23
Lancet (London, England), 2024 Mar 20
Lancet (London, England), 2023 Dec 01
Lancet Oncol, 2020 Sep 10
Annals of oncology : official journal of the European Society for Medical Oncology, 2024 Sep 14
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2024 Oct 16
Obstetrics and gynecology, 2018 Oct
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2022 Jul 20
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2022 Oct 06
Int J Radiat Oncol Biol Phys, 2020 Mar 1
Radiation oncology (London, England), 2021 Jun 14
Seminars in radiation oncology, 2016-04
Advances in radiation oncology, 2017
Gynecologic oncology, 2018-10
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2024 Apr 04
N Engl J Med, 2023 Mar 2
The New England journal of medicine, 2024 Jun 02
The New England Journal of Medicine, 2024 Feb 29
JAMA oncology, 2024 Jul 01
The American journal of surgical pathology, 2014-06
The American journal of case reports, 2020 Feb 08
Pathobiology : journal of immunopathology, molecular and cellular biology, 2020 Jan 23
Gynecologic oncology, 2012-11
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2024 Aug 24
Lancet (London, England), 2024 Oct 11
Annals of oncology : official journal of the European Society for Medical Oncology, 2024 Sep 14
Gynecol Oncol, 2021 Feb 1
Therapeutic advances in medical oncology, 2024 Sep 28
Frontiers in pharmacology, 2019 Apr 26
The oncologist, 2020 Apr 28
Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie, 2021 Jun 18
Gynecologic oncology, 2019 Oct 31
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2022 Mar 18
Obstetrics and gynecology, 2024 Nov 07
Diagnostics (Basel, Switzerland), 2024 Nov 16
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2022 Mar 25
Gynecologic oncology, 2024 May 17
Annals of oncology : official journal of the European Society for Medical Oncology, 2024 Feb 01
Lancet (London, England), 2024 Sep 14
Lancet (London, England), 2024 Oct 14
N Engl J Med, 2017 Nov 16
N Engl J Med, 2021-04-01
Gynecologic oncology, 2005-09
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2020 Jul 15
Gynecologic oncology, 2020 Jul 21
Gynecologic oncology, 2013-02
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2012-11-01
Cancers, 2022 Apr 13
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008 Feb 20
Annals of coloproctology, 2014 Aug 26
Gland surgery, 2020 Apr
International journal of radiation oncology, biology, physics, 2018-11-15
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2023 Nov 06
Annals of oncology : official journal of the European Society for Medical Oncology, 2025 May 30
Lancet (London, England), 2025 Jun 02
Annals of oncology : official journal of the European Society for Medical Oncology, 2025 Jun 02