Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Do you wait until a ureteral stent is placed to plan a locally advanced cervical cancer with hydronephrosis?
The simple answer is YES. We typically wait for ureteral stent placement before we start the radiation treatment planning process because of many potential benefits to the patient such as improving the patient's renal function status so she would better tolerate the full dose of cisplatin chemothera...
How do you manage a FIGO stage IB dedifferentiated endometrial carcinoma that is MMR deficient and p53 wt?
Aggressive disease. Favor chemo plus IO (MMR-d) (Van Gorp et al., PMID 39284383) followed by EBRT.
What is the best treatment for a medically inoperable endometrial adenocarcinoma of the uterus FIGO 1, grade 1, type 1?
I would get a pelvic MRI to assess tumor size and myometrial involvement. If small volume (2 cm or smaller) with superficial invasion then use brachy alone, otherwise EBRT plus brachy. The type of brachy is based on uterine width: If the width is less than 5 cm: single tandem and cylinder. Otherwise...
Would you prescribe vaginal estrogen cream for vaginal dryness to a patient in her 40s with a history of stage IA granulosa cell tumor?
Systemic serum absorption after use of low-dose vaginal estradiol inserts (such as 10 mcg estradiol tablet or 7.5 mcg/day estradiol ring) is very low. One study (Notelovitz et al., PMID 12039110) showed that baseline serum estradiol levels were 7-8 pg/ml in postmenopausal women. With the use of a 10...
How would you sequence adjuvant chemo-immunotherapy (paclitaxel/carbo/pembro or paclitaxel/carbo/dostarlimab) with EBRT and vaginal cuff brachytherapy in advanced uterine cancer that meets clinical criteria for both EBRT and chemo-IO?
A common misapplication of RUBY/GY018 is giving IO in patients with non-measurable advanced uterine cancer. Radiation as part of the trial was not included in these studies. The role for chemo-IO vs chemo alone (with or without radiation) for high risk non-measurable uterine cancer was tested in GOG...
Given the results of KEYNOTE-A18, do you plan to recommend adding pembrolizumab to primary chemoradiotherapy for advanced stage cervical cancer?
Until the paper gets published, we won't really know a lot of details that may influence the potential utility of this regimen. It has an abstract/presentation and has recently received FDA approval.It is a relatively 'newer' idea in improving outcomes that we as an institution are open to start off...
How do you manage early stage I uterine serous carcinoma?
The management of these patients remains controversial. The data are conflicting and treatment choices tend to be based more on impressions than solid data. Most clinicians advocate chemotherapy although randomized trials have not clearly shown benefit for this subset. For stage IA, we typically tre...
How do you boost a positive parametrial margin in endometrial cancer after TAH BSO?
For a patient with a positive margin, we would first want to image post-operatively to make sure there isn't any gross disease. MRI is most helpful for this. The goal for the dose would be to treat this region to about 60 Gy. We would initially treat the pelvis to 45 Gy with an integrated boost at t...
Do you add trastuzumab to adjuvant chemotherapy for patients with Her2+ stage I-II high grade serous uterine cancer following surgical staging?
No, I don’t routinely add trastuzumab to adjuvant chemotherapy for early stage Her2+ serous endometrial cancer patients. There are no data supporting its use in this manner. My recommendation is to offer her treatment on GY026, a study enrolling both early and late-stage serous endometrial cancer pa...
How would you manage a young, healthy patient s/p open radical hysterectomy/bilateral salpingectomy/ovarian transposition/bilateral SLND with now stage IB3 HPV-dependent adenosquamous cervical carcinoma?
Adjuvant chemo/RT