Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
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.
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...
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...
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...
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...
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...
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...