Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How would you manage a cervical cancer patient with bulky PA LNs with direct extension and/or invasion into the lumbar vertebral bodies?
I would treat with definitive intent. May do chemo IO first and then definitive chemo RT.
Do you give vaginal cuff brachytherapy and/or whole pelvis, for patients with Stage III endometrial adenocarcinoma?
Depends on the substage and extent of surgical staging: Stage IIIa serosa: I give pelvic RT alone often following chemotherapy. I would also add vag brachy in cases of cervical stromal invasion. Stage IIIa adnexae. Same as (1). Stage IIIb. I give pelvic RT plus vaginal brachy often following chemot...
How do you best manage bulky, clinical stage IIA squamous cell cancer of the cervical stump in a patient with a previous partial supra-cervical hysterectomy?
This is not a common scenario in the clinic. It is an older type of surgery to do supracervical Hysterectomy. For stage IIA Sq. cell ca of Cx in the stump, I would start with chemoRT to pelvis to 45-50GY and then depending on the length of the stump if at least 2.5-3cm would offer intracavitary bra...
What strategies have you found to be most helpful in improving patient compliance with vaginal dilator use after pelvic radiotherapy?
We attempted a randomized feasability trial to a study dilator use and test a theoretically driven enhanced educational program (EEP) to increase adherence, We did not find increased adherence to the EEP program. At present, other than good physician and nursing counselling, I am unaware of signific...
What factors do you use to determine whether to add brachytherapy to EBRT for IIIC endometrial cancer?
My philosophy is to use 45 Gy in 25 fractions of EBRT followed by two fractions HDR boost.
Is there any benefit to giving pelvic radiation prior to systemic chemotherapy or vice versa for a patient with stage IIIA uterine serous carcinoma?
At our institution we take the data from PORTEC III and generally apply it to all patients with Stage III disease given the improvement in OS and DFS. This was one of the largest inclusions of serous patients at 16% in either group, although still a relatively small number. With this in mind, I also...
Would the findings of a synchronous T1a ovarian endometrioid adenocarcinoma affect your treatment recommendation for a IB, G2 uterine endometrioid adenocarcinoma and LVSI?
These cases are always difficult to know if it is synchronous primary or metastatic disease and sometimes pathologist are able to clarify and other times not. Outcome is significantly better if they are synchronous primary as it appears to be the case here. If ovarian surgical staging is done, I wou...
Would you offer adjuvant therapy following successful resection of a solitary lung recurrence of leiomyosarcoma if no other evidence of recurrent disease on PET CT?
It is reasonable to observe this patient if no evidence of other disease and surgical margins were obtained, however, many would offer adjuvant chemotherapy or radiation to the bed of the resection. If the patient had a prior treatment at the initial diagnosis, another sarcoma chemotherapy regimen c...
How would you approach radiation in a patient with IIIC2 SCC of the cervix with a history of ileoanal reanastomosis and j pouch?
Depends a bit on the specifics of the case (e.g. how big is the cervix?), but in general, I would limit the pelvic dose to around 40 Gy and push the brachytherapy dose a bit higher. For the brachytherapy, the use of image guidance potentially provides an opportunity for further limiting the dose to ...
Would you consider staging lymph node dissection for a patient referred for stage IA endometrial cancer and MELF pattern on final pathology?
With no other risk factors like LVSI, grade 2 or 3, or outer half myometrial invasion, I recommend surveillance.