Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What is the optimal adjuvant vaginal brachytherapy schedule when a patient is getting concurrent chemotherapy?
I offer 7 Gy x 3 weekly, but prefer 6 Gy x 5 to surface regardless of when chemotherapy is given. We have some currently unpublished, but upcoming institutional research submitted to ABS 2025 that showed increased risks of vaginal stenosis with 21 Gy in 3 fx to depth compared to a more gentle fracti...
How would you approach a young patient with a locally advanced endometrial cancer with cervical involvement and a solitary bone metastasis?
I would need to know what is meant by locally advanced endometrial cancer. Locally advanced cervical cancer usually means not operable (except IB2) so is this a T3N?M1 pt with a bone met? That is IVb. I agree with bone biopsy but endo does go to bone so I would not be surprised if this was positive....
How would you approach treatment for a primary carcinosarcoma of the cervix with pelvic and para-aortic nodal involvement?
There is limited information on this situation. A series from Washington University (Gynecol Oncol 2005; 99: 348) demonstrates that curative intent treatment can be rewarded with long term survivals if disease is confined to the pelvis. Curative treatment could include chemo-RT, radical surgery, or ...
How do you address extended break from EBRT during cervical cancer treatment?
EMBRACE data suggest HRCTV dose needs to be increased by 5 Gy for each week delay beyond 50 days to counter the downside of delay. We try to do that using hybrid applicator but total dose is still limited by OAR dose and we try to push as much as we can. (HRCTV to 90-95 Gy)
Would you offer adjuvant RT to a FIGO IV endometrial CA with pulm mets s/p hysterectomy with residual disease, then cCR to both sites after chemotherapy?
For stage IVB with extra pelvic mets to lung or liver, I have not offered adjuvant RT as the high risk of other mets would negate any benefit of adjuvant RT. If they develop isolated local relapse, then would consider for salvage.
Is there a difference in the incidence of serious immune-related adverse events with the lenvatinib + pembrolizumab combination vs pembrolizumab alone in endometrial cancer?
Yes, high risk of both hypertension and diarrhea. The diarrhea can be very difficult to manage. The lenvatinib definitely adds a level of complexity to the management of pembro side effects. This requires dose reductions and interruptions, maybe even hospitalization for dehydration/renal insufficien...
Do you offer patients with advanced endometrial cancer lower starting doses of lenvatinib when used in combination with pembrolizumab given high adverse event rates with 20 mg daily?
For the first part of the question, "Do you offer patients with advanced endometrial cancer lower starting doses of lenvatinib when used in combination with pembrolizumab given high adverse event rates with 20 mg daily?" The strategy of administering lenvatinib therapy by starting at the established...
What would you recommend in the adjuvant settings for an elderly patient status post hysterectomy without nodal staging and was found with FIGO 1A, G3 endometrial cancer, with no LVSI and no myometrial involvement, without nodal staging?
Imaging for staging. Brachytherapy alone as adjuvant treatment.
How would you manage bulky cervical adenocarcinoma that incompletely responded to primary chemoradiation?
At the time of surgery, should be evaluated to see whether a radical hysterectomy is visible because of residual disease in parametria and the patient should be prepared for an anterior exenteration if needed.
What is your preferred first line systemic treatment for recurrent, metastatic, low grade, ER/PR+ pMMR endometrioid endometrial carcinoma?
Given the data presented at the most recent SGO Annual Meeting on Women's Cancer, published simultaneously in the New England Journal of Medicine, and recently endorsed by the National Comprehensive Cancer Network (NCCN), the standard of care for recurrent endometrial cancer, regardless of MMR statu...