Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Do you recommend adjuvant pelvic RT for Stage 1 cervical adenocarcinoma?
At M.D. Anderson we do treat histology as a independent high risk factor - but only moderately to poorly differentiated adenocarcinomas. Grade 1 adenocarcinomas are considered low risk and that histology is not considered as an independent risk factor. So if the case is borderline and the patient ha...
What is the optimal management of a pelvic sidewall recurrence of endometrial cancer in a patient who has not previously received radiation?
A significant percentage of women with a pelvic sidewall recurrence can be salvaged with definitive chemoradiation. We would typically use IMRT, treating a CTV encompassing the pelvic nodes to 45-50 Gy and using an initial integrated boost to treat the gross disease to 50-55. A sequential boost to b...
When do you offer observation for resected stage II endometrial cancer?
Fortunately, this is an uncommon situation. Even with stage II disease, there is no clear advantage to radical hysterectomy, and it subjects the patient to higher surgical morbidity, especially genitourinary. To my knowledge, data is sparse in terms of when it is appropriate to withhold any adjuvant...
How do you plan urgent radiation therapy for vaginal bleeding caused by locally advanced cervical cancer?
Agree with @Dr. First Last, we do the same and start at 1.8. Vaginal packing (you can treat with the packing in), transfuse if needed given bleeding. 4-field to start and can turn around a box within a couple hours, and then switch to IMRT as soon as approved. We also try to start the chemo quickly....
Do you offer pelvic radiation for endometrial cancer with ITCs in the node(s) and no other high or intermediate risk factors?
This is an uncertain area with limited outcome data. Ultrastaging with SNLN is picking up more ITC of which the clinical significance is unclear and may result in overtreatment. The data suggests ITCs have much better outcomes then micro or macromets but possible inferior outcome to node negative di...
For stage IB1 cervical cancer s/p surgery with only 1 Sedlis criteria, should adjuvant pelvic EBRT or vaginal cuff brachytherapy be recommended in the presence of other adverse pathologic features, such as high tumor grade or very close but negative margins?
For patients with close margin would offer EBRT plus brachyhttps://www.ncbi.nlm.nih.gov/pubmed/16750323
When would you add a vaginal cuff brachy boost to external beam radiation for uterine carcinosarcoma?
No prospective data but based on pelvic recurrence pattern suggesting cuff being commonest time, our approach 45 Gy in 25 fractions followed by 2 fractions HDR brachytherapy.
Do you routinely check tumor genomics, including POLE status for new endometrial cancers?
This is an evolving question! My first comment is if it's not going to impact your treatment decisions, probably best not to order. But with increasing data to suggest the POLE mutated tumors may not require as intense therapy, it would certainly be reasonable to order - especially as a "tie-breaker...
How do you treat a Stage I endometrial squamous cell carcinoma?
We have generally managed with same principal as endometriod histology
How would you sequence chemotherapy and radiotherapy for a patient with stage IIIC1 serous endometrial carcinoma?
Update to Recommendation (3/2025): Clinical trial data supports incorporating immunotherapy with chemotherapy in the adjuvant setting for this group of patients. My recommendation for a patient with Stage IIIC1 serous endometrial cancer depends on the HER2 status as follows: HER2+: Chemotherapy + t...