Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you treat endometrial cancer in the setting of a pCR after neoadjuvant chemotherapy?
There is no data to guide. I would favor pelvic RT based on initial stage IIIB disease. We, at our institution, usually treat these patients with neoadjuvant chemo RT followed by surgery.https://www.ncbi.nlm.nih.gov/pubmed/25218303
How do you match a para-aortic field to a previously irradiated whole pelvis field in a woman with PA nodal failure after definitive chemoRT for cervical cancer?
We try to treat entire PA region and match to pelvic field (match two 50 percent isodose line) with .5 to 1 cm of safety factor based on nodal location
What alternative boost methods (techniques / dose) do you recommend for a vaginal cuff boost after whole pelvis when imaging shows bowel adherent to the vaginal cuff?
I usually prescribe to surface in these scenario rather than thickness. 6Gy x2
Are you using the new FIGO 2018 staging or waiting until it is incorporated into the next AJCC edition?
It will take 6-8 months for the incorporation into AJCC. Since our tumor registry follows AJCC, we are waiting for it to be done for uniformity of reporting.
Would you recommend radiotherapy for a para-aortic recurrence of endometrial cancer in a patient who previous completed surgery, chemotherapy, and WPRT?
Yes, as a set of these patients are cured. I would treat pa chain with SIB to node along with concurrent cisplatinum to definitive dose
If a patient with recurrent endometrial cancer experiences minimal or slow disease progression on pembrolizumab or pembro/lenvatinib, would you consider continuing or would you change agents?
Great question with unfortunately no perfect answer. There are several things that need to be considered if there is slow or minimal progression. Is this true progression (patient is on immunotherapy)? How well is the patient tolerating the therapy (are toxicities worth the benefit in this patient)...
How would you approach adjuvant therapy for a IIIC2, FIGO grade 2, endometrial cancer with 1/7 positive (para-aortic) lymph nodes?
Hopefully, that node removed at surgery. Would extend xrt fields to cover with chemo.
How do you plan for excess nonconforming vaginal tissue with a HDR cylinder?
CT based plan. You do end up seeing paravaginal tissue not covered by single channel cylinder. We have not chased that in adjuvant setting with outcome data showing low recurrence rate. Similar thoughts about small air gaps Richman et al., PMID 33384254.
What is the best method for ensuring that vaginal cuff cylinder is in proper position at each fraction?
The best method depends on local context and what tech is available. For imaging, one can: re-CT each treatment, use fluoro (we have a C-arm), use the kV or MV imager on a Linac with an orthogonal pair or a CBCT. There are other methods also. Some practices don’t image verify (makes me nervous). For...
What is your approach to an incidental diagnosis of low risk endometrial cancer in a patient who underwent minimally invasive hysterectomy with uterine morcellation with gross intra-operative tumor spillage?
Little guidance is available in the literature on the optimal management of a patient with a low grade endometrial cancer who had a minimally invasive procedure with uterine morcellation and gross tumor spillage. Fortunately, this situation is not common. Wright et al. estimated the risk of occult m...