Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
When would you consider sequential chemotherapy and radiation rather than concurrent for early stage cervical cancer with high risk pathologic features?
How much of the results of the STARS (Huang et al., PMID 33443541) (showing improved DFS with SCRT compared to CCRT) driven by only a 62% completion rate of CCRT (compared to 73.4% in SCRT, p< 0.001) as per the specified protocol is unknown.While the authors state within their results section that t...
How would you deliver pelvic radiation as cost-efficiently as possible for a patient with endometrial cancer?
I think that a 4 field plan to 45 Gy in 25 fractions without cuff brachytherapy would reduce cost without deviating from the standard of care. We would expect that to come with modestly more acute and chronic toxicity than IMRT. I think we need more evidence before a 5 fraction regimen could be reco...
Is obesity a risk factor for recurrence after definitive treatment for endometrial cancer?
The most common cause of death in early stage endometrial cancer is not cancer but cardiovascular. Anything to reduce cardiovascular risk would help reduce mortality
Do you add chemotherapy to salvage EBRT/brachytherapy for a pt with small vaginal cuff recurrence of cervical CA s/p hysterectomy?
Yes, we do treat with concurrent chemo radiation (not much data).
How do you manage a screening pap smear result of HSIL and HPV16+ in a first trimester pregnancy?
Colposcopy to rule out invasion; if invasion is suspected, then biopsy. Otherwise, wait until delivery and re-evaluate. It is unlikely that invasive disease will develop in the short time of gestation. I believe these are the ASCCP guidelines.
How would you proceed with the management of a healthy patient with stage IV grade 3 endometrioid uterine cancer metastatic to the right diaphragm and other peritoneal surfaces?
Enroll the patient in a clinical protocol.
How would you treat a patient with pT1bN0 G1 endometrioid carcinoma with significant MMI (~80%) and +LVSI?
Brachy alone, unless substantial LVSI then would favor EBRT.
Do you include trastuzumab in the treatment regimen of patients with advanced stage HER2+ endometrial cancer that is NOT serous or carcinosarcoma?
Yes, I do, and other anti-HER2 agents as well, especially for those with recurrrent disease.
Is it ever acceptable to treat low pelvis (vs. whole pelvis) for an early vaginal recurrence of endometrial cancer?
Retrospective data suggest pelvic RT helps but the volume of pelvic RT is variable as much of the data is in the 2D era. I usually treat common, external, and internal iliac in recurrent disease but would be reasonable to exclude common illiac node if morbidity is a concern.Vargo et al., PMID 252419...
When, if ever, would you offer adjuvant radiation to a patient with stage IVB endometrial cancer following neoadjuvant chemotherapy and cytoreductive surgery?
Stage IVB can have a large spectrum based on the extent and volume of metastatic disease. The NCDB dataset has lots of selection bias in who gets EBRT and also no data on DFS or recurrence pattern. I have usually avoided adjuvant RT unless pelvis is only confined to stage IVB disease.