Gynecologic Cancers   

Questions discussed in this category



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...

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 your management change given that this recurrent lesion is over 10 cm and the patient previously achieved complete response on immunotherapy 5 y...

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.

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...

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...

Re-staging is otherwise negative; patient's disease has FIGO grade 1 endometroid histology

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 is a female in her 40s. No mucosal changes were evidenced on clinical exam. Chemo-RT is recommended by GynOnc at an academic center. ...

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...

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...

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 ...

If so, what would your target volumes and doses be? How would you sequence with immunotherapy (eg nivolumab)?

No LN dissection was performed as it was for a suspected CIN III. Final pathology showed +LVSI, -margins (>10mm), -parametrial extension, and 1.2mm...

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...

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...

The trial showed an overall survival benefit of 8% at 5 years with induction chemotherapy (80% vs 72%) utilizing at least 5 cycles of carboplatin-pacl...

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?

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 ...

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...

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?

Interstitial implant was attempted under laparoscopic guidance (due to pre-brachy MRI showing potential bowel involvement). At the time of procedure, ...

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...

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 ...

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...

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...

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.

Do you treat the whole bladder in the intial whole pelvic field to 45-50 Gy?

Close but negative radial margins? LVSI? What fractionation/dose do you use for your vaginal cuff boost if used? 

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...

How do you take into account pathologic factors like %clear cell histology, myometrial invasion, and LVSI?  

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...

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?

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...

When would you use 5-fluorouracil instead of, or in addition to, cisplatin during chemoradiation? When, if ever, would you offer adjuvant hysterectomy...

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...

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?

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...

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? 

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...

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? 

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?

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?

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

<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?

How long after hysterectomy would you consider delivering adjuvant radiation therapy? Would this differ for external beam versus brachytherapy? Are t...

Do you prophylactically start all patients on B12, B-complex, and/or omega-3? If so, what dose? What about ice mittens and booties?

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?

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?

Do you increase EBRT or brachy dose by a certain amount based on interval? 

If so, what dose would you recommend? What other management options would you consider? 

Treat as invasive disease with concurrent chemotherapy? Any non-radiation options for large in-situ disease? If RT, would you include at least inguina...

What is the impact among patients and providers? Has your documentation been adjusted now that patients can readily review?

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...

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...

Assuming the nodal assessment is minimally invasive and the patient is otherwise healthy without postoperative complications.

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...

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...

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 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...

Is anticoagulation for PE an absolute or relative contraindication to IS brachy? Would you favor placement of IVC filter prior to procedure?

History of CDH1 mutation and prophylactic gastrectomy in 2017 - no other primary site found beyond vagina at diagnosis. Vaginal tumor completely resp...

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...

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?

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 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)...

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...

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?

Primary R0 debulking in 2018 followed by Carbo/Tax for 6 cycles, and single agent Bevacizumab followed by Letrozole, now again with NGR

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. 

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?

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...

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. 

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...

Would you change your approach based on platinum sensitivity or other factors?

Disease involves the lungs diffusely and bilaterally. If only palliative treatment is recommended, what should be the target volume (primary only? pr...

In the unfortunate setting where you cannot get an underinsured patient whose policy does not cover radiotherapy started on treatment without guarante...

There are mixed recommendations about re-testing vs simply waiting for a quarantine period prior to resuming therapy. 

EP vs C/T? Would you perform additional imaging, ie. PET Dotatate to evaluate for metastatic disease?

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...

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...

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...

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...

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 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...

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.

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...

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...

http://abstracts.asco.org/199/AbstView_199_180760.html http://abstracts.asco.org/199/AbstView_199_187537.html  

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?

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...

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...

How do you prevent early menopause in women? Please comment on freezing of eggs, oophopexy, supine vs prone position, vaginal dialator. 

 Specifically, if they are to be treated similar to GI cancers that receive FOLFOX/EPIC

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 ...

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...

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 ...

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...

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...

Would you be more or less likely to use a cisplatin-containing regimen if a patient had previously responded to chemoradiation with concurrent cisplat...

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 ...

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?

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...

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...

At what point would you introduce the discussion of weight management, whether for risk reduction or overall health?

The NCCN recommends either systemic therapy + brachytherapy or pelvic RT + brachy or brachy alone or observation. How do you decide among these option...

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...

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...

Two new phase 2 studies this year with apatinib/oral etoposide (AEROC) and sorafenib/topotecan (TRIAS) were released, and NCCN also lists many single ...

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...

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...

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...

Would you deliver definitive RT in place of inguinal lymph node dissection in light of new data (PMID: 29336837) In the case of high risk but radiogr...

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?  

In a patient who underwent laparoscopy for endometriosis and was found to have a 1mm focus of neuroendocrine tumor, would you recommend further surger...

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...

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...

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...

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 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) ...

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?

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)?

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...

My patient’s family has asked that I don’t tell her that she has metastatic cancer because it will devastate her. I am planning on palliat...

The patient failed previous excisions and medical therapy and is no longer a surgical candidate.

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.

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?


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