Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Would you include a seroma in an adjuvant radiation field for post-op endometrial cancer?
The general principle I follow is if I can include it safely, I would. Otherwise, would skip most of it (lymphocele). If lymphocele is the site of positive pathological node, then include it in CTV.
What brachytherapy regimen would you use for a patient who completed only the EBRT portion of their planned definitive chemoradiation course for locally advanced cervical cancer, who is now presenting with persistent/recurrent local disease?
I would favor exenteration. If not possible, then would favor chemo to downsize followed by brachy or brachy alone with total dose based on cumulative dose to rectum and bladder. At least aim for EQ2 of 40 Gy or above to HRCTV with hot spot in GTV to a higher dose.
What are your top takeaways in Gynecologic Cancers from ASCO 2023?
Gynecologic oncology research was strong at ASCO 2023. Results of the following 3 pivotal studies are practice changing. Marie Plante, MD: SHAPE trial: This non-inferiority CCTG (Canadian Cancer Trials Troup) trial enrolled 700 patients with low-risk squamous cell carcinoma, adenocarcinoma or adenos...
Would you include a lymphocele in your IMRT treatment volumes for endometrial carcinoma?
We only include the lymphocele is there is a positive node in the area of the lymphocele. If the nodes are not positive in the area of the lymphocele - we do not include the entire lymphocele.
What lessons can we learn from RTOG 0418 in how to best use IMRT to treat endometrial cancer?
Despite an atlas and detailed instructions, there were still problems noted with contouring. I think the most important lesson is the need for careful contouring and the use of an ITV comprised of a fusion of full and empty bladder scans. I encourage people to place patient’s on RTOG 1203 – which ra...
Once endometrial cancer recurs after no chemo or XRT, is it curative or palliative?
It depends on where the recurrence is. if it is a pelvic recurrence in the vagina or a nodal recurrence in the pelvis or PA region, then the goal of treatment is curative, although the salvage rate is much higher for vaginal recurrences than for nodal recurrences. The salvage rate is also a function...
How do you define and IR-CTV for cervical brachytherapy?
Since most outcome data based on HRCTV dose , I don't routinely contour or monitor dose to IRCTV for cervical cancerhttps://www.ncbi.nlm.nih.gov/pubmed/30605752
How do you counsel patients with BRCA-1 mutations regarding the role of hysterectomy as a part of risk-reducing surgery?
I routinely offer hysterectomy at the time of risk reducing BSO for BRCA1 mutations. There is an approximate ~3% risk of serous uterine cancers in these patients (Uterine Cancer After Risk-Reducing Salpingo-oophorectomy Without Hysterectomy in Women With BRCA Mutations). Additionally, in patients wh...
Would you give additional radiation for a positive margin after salvage hysterectomy for a patient with cervical cancer who had initial definitive chemoradiation with EBRT+T&R?
Patients usually have radical hysterectomy, so repeating surgery is not an option for most cases. I may recommend vaginal cuff brachytherapy in this case.
How successful is IVF after definitive radiation therapy to the pelvis for endometrial cancer?
The most extensive data regarding the effects of uterine RT are for pre and peri-menarchal girls. Although women who had pelvic RT as children can often become pregnant if the ovaries are still functional, even doses as low as 10-20 Gy cause atrophic development of the uterus with decreased uterine ...