Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
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
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...
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.
How do you treat a Stage I endometrial squamous cell carcinoma?
We have generally managed with same principal as endometriod histology
Would you recommend adjuvant therapy for a 1A grade 2 endometrial adenocarcinoma with MELF pattern, and ITCs in one pelvic lymph node?
I would also favor a diagnostic CT scan. If both sides SNLN mapped, based on a favorable intrauterine factor, would favor brachy vs observation.
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...
In cervical cancer, is the presence of parametrial LNs with ITCs considered parametrial disease requiring adjuvant chemo +/- RT?
Depending on the patient's general condition and performance status, I would consider adjuvant treatment with chemoradiation. In this case, although there was a good pelvic lymph node dissection with 29 negative right and left pelvic nodes, there are positive parametrial nodes with ITC. One could co...
What is your approach to a cervical cancer in a patient with a previous supra-cervical hysterectomy?
I have had 2 patients with this scenario. Given that the primary site of disease remained intact, I chose to treat fundamentally the same as I would otherwise treat an intact cervix. Both were early-stage and underwent CRT with planned insertions intended to limit total treatment length to under 56 ...