Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What is optimal therapy for a 5 year delayed recurrence of uterine cancer, rendered NED by solitary pulmonary metastasis resection?
I favor “pseudoadjuvant” therapy with carboplatin + paclitaxel chemotherapy for 6 cycles. I make this recommendation in the absence of strong data to suggest an improvement in outcome with chemotherapy over observation vs. hormonal therapy. The optimal therapy for this patient with recurrent endomet...
For a patient with cervical cancer s/p chemoRT, would you consider brachytherapy to downstage tumor to allow for hysterectomy rather than pelvic exenteration?
I am not clear as have not encountered this situation. I would complete chemo RT including brachy to definitive dose and reserve surgery as salvage if there is persistent disease 12-16 weeks after treatment.
When do you include the presacral nodes in post-operative XRT of endometrial cancer?
Cervical stromal invasion (pT2) or for definitive radiation for nodal or vaginal recurrence when treating the whole pelvis.The new Gyn postop atlas recommends if in including presacral to treat down to the pyriformis muscle. Historically, RTOG/GOG recommended S1-S3. PORTEC-3 used a 10mm in front of ...
If a patient with HER2+ uterine serous carcinoma recurs while on maintenance trastuzumab, would you continue trastuzumab with second line chemotherapy?
I advise against extrapolating data from breast cancer therapies to endometrial cancer. There is no clinical trial supporting the administration of trastuzumab (or other anti-HER2 therapy) with second line chemotherapy after progression on maintenance trastuzumab in serous endometrial cancer. Rather...
How do you manage a distal vaginal recurrence of endometrial adenocarcinoma in a patient who had adjuvant external beam and cylinder brachytherapy boost to the top 4 cm of the vaginal cuff?
I would treat with EBRT to primary plus both inguinal regions followed by image based brachytherapy. Would add concurrent chemo if bulky disease. Dose of EBRT adjusted based on overlapLing et al., PMID 30600093
How would you treat a recurrent endometrial cancer at the vaginal cuff that was initially FIGO 1A with no adj treatment, in a patient with actively treated scleroderma?
I would favor brachytherapy alone using MRI based planning with either a multichannel or hybrid applicator. Dose 6 Gy x 6 to CTV and higher dose (hot spots) to GTV.
How would you treat completed resected rectosigmoid recurrence of endometrial adenocarcinoma?
We have equally treated with chemotherapy for recurrence followed by involved site with RT in a few cases for isolated extended pelvic relapse. Overall outcome has been mixed.
How would you manage a patient in her 50s with FIGO IA clear cell carcinoma of the endometrium with extensive LVSI and ITCs in an obturator node after 6 cycles of carbo/taxol?
I would favor EBRT plus brachy boost.Here is a review and our treatment philosophy Musunuru et al., PMID 35248784
How would you treat an endometrial cancer with pelvic sidewall nodes, patient s/p TAH/BSO but nodes were fixed and unresectable?
We would treat with IMRT and IGRT with concurrent cisplatinum based chemotherapy, with SIB boost dose to involved nodes (dose based on size and proximity of critical organs) followed by adjuvant chemo.
What is the maximum time you would wait after hysterectomy to start RT for a FIGO II endometriod adenocarcinoma before cancelling treatment and saving for salvage?
Great question, and I don't know that there is a perfect answer. If I were going to answer with some specificity, I would say 4 months. Obviously this is not ideal. However, in the presence of more compelling indications for treatment (your question relates to stage II patients/stromal invasion), I ...