Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What post-treatment surveillance strategy do you employ for patients who undergo conservative fertility-sparing surgery for early-stage cervical cancer?
For patients undergoing fertility-sparing surgery for early-stage cervical cancer not dissimilarly to any other patient treated for early-stage cervical cancer. I would recommend that the patient undergo a history and exam, including a pelvic exam, every 3 months for the first 2 years, then every 6 ...
What does bevacizumab contribute in metastatic cervical cancer when used in combination with a platinum doublet + pembrolizumab?
I'm not sure how to answer the question. GOG 240 established paclitaxel/carboplatin/bevacizumab as the standard for first-line therapy for metastatic or recurrent cervical cancer.The BEATcc trial was a subsequent phase III trial for stage IVB, recurrent or metastatic cervical cancer that randomized ...
How do you manage early stage uterine carcinosarcoma?
Unfortunately, no good prospective study has shown an impact on survival with any adjuvant treatment. Based on relapse patterns at our institution for surgically staged IA disease, it is chemotherapy (ifosfamide plus taxol) plus cuff brachy. For all other stages, it is usually chemo as above followe...
Would you offer adjuvant radiation in addition to chemotherapy for a patient with stage IIIC uterine carcinosarcoma with cervical involvement?
This is a hard situation as there is no clear data for the exact treatment plan. For surgically staged patients with stage IIIC uterine cancer our tumor board treatment plans typically include discussion of PORTEC-3 (de Boer et al., PMID 31345626) and GOG-258 (Matei et al., PMID 31189035). Patients ...
What are your top takeaways in Gyn Cancers from ASCO 2025?
We had some exciting abstracts for ASCO 2025! These gynecologic oncology abstracts highlight some truly impactful advancements. Here's a concise breakdown of the key findings and their potential implications: 1. CALLA Trial – ctDNA Detection in LACC (Abstract #5502, Dr. Mayadev et al.)Study Focus: E...
Do you offer ovarian transposition to premenopausal cervical cancer patients prior to chemoradiation therapy?
Ovarian transposition or oophoropexy is definitely something to consider in premenopausal patients prior to chemoradiation for cervical cancer. Ovarian function is sensitive to radiation with as little as 2Gy leading to permanent ovarian insufficiency via follicular loss, limiting follicular maturat...
What is your approach to the adjuvant treatment of early-stage mixed-histology endometrial cancer with a significant clear-cell component?
Clear cell carcinomas are under-represented in most clinical trials and hence, clear evidence-based recommendations are difficult to make. Even a small percentage of clear cell is sufficient to label these as “high grade”. The recently published ASTRO guidelines mention that chemotherapy may not ben...
Do you routinely perform bilateral oophorectomy at the time of hysterectomy for a premenopausal woman with a uterine leiomyosarcoma that appears to be limited to the uterus?
Since this is an unusual cancer, there is not a whole lot of data on this subject. Having said that, the literature has suggested that the chance of ovarian mets in a stage 1, 11 is 2-5%. As a result, this factor is not a major consideration in regards to survival. In a patient so presented, would n...
When utilizing KN-A18 protocol, how do you best address symptoms of colitis/cystitis?
I have now anecdotally heard of 2 patients not completing EBRT/Brachytherapy due to the combined AI colitis picture superimposed on a traditional chemoRT GI toxicity. While there were reasons for patients to not complete pre-ICI, those reasons were generally not because of GI toxicity. The main thin...
Should women with adequately debulked ovarian cancer receive bevacizumab with chemotherapy in the adjuvant setting?
The answer to this question is definitively NO.Two large, definitive studies (ICON-7 and GOG218 – including over 3400 patient combined) evaluated the impact of adjuvant chemotherapy with concurrent + maintenance bevacizumab. Analysis of mature data from ICON-7 demonstrated a significant overall surv...