Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
For a patient with recurrent endometrial cancer involving the vagina with a good response to EBRT (<5mm residual), how would you prescribe adjuvant brachytherapy with a cylinder to the entire vaginal length?
We focus on pre EBRT length, as recurrence patterns don’t support needing to treat the full length with 45Gy from EBrT sufficient, and series that have treated full length have shown higher toxicity.See discussion of this for summary of literature for volume of treatment.
What chemotherapy options are there for clear cell carcinoma of uterus with progression of disease on carboplatin and paclitaxel?
In the absence of prior radiation, localized disease may be radiated or surgically removed. For systemic disease, general recommendations for recurrent clear cell cancer of the endometrium are generally the same as for most histologies. The NCCN lists several regimens after failing front-line carbo/...
How would your follow-up change for a patient, non-surgical candidate, with endometrial cancer treated with definitive radiation?
I assume that the question refers to how follow-up would differ between a patient treated adjuvantly, i.e., following surgery, versus treated definitively, i.e., not a surgical candidate. I think there are quite a few variables here. Probably the most important consideration is the extent to which t...
Would you offer definitive RT to a patient with metastatic cervical adenocarcinoma s/p carbo/taxol/avastin with a partial response in the metastatic sites?
I have delivered definitive pelvic chemoradiotherapy to a handful of patients who had complete radiographic responses to neoadjuvant TCA. All patients remain disease-free several years later. As for a patient with only a partial response, I believe there is still a good argument to be made for the a...
Would you modify standard WPRT+brachy radiation for cervical SCC s/p negative nodal staging but aborted hysterectomy due to previously undetected superficial vaginal disease?
Would treat same with EBRT to 45 Gy in 25 fractions. (Pelvis) With concurrent chemo and brachy.
Would you offer any adjuvant therapy for cervical cancer following total pelvic exenteration in the setting of a positive pelvic lymph node?
I am going to "eat a bit of crow" here and admit to having been schooled a bit by the esteemed Dr. @Dr. First Last. I admit to having immediately jumped to the post-rad hyst situation rather than post-exenteration, and I agree that the radicality of the operation could factor into the decision about...
Are there any data that suggest superiority of lenvatinib + pembrolizumab vs platinum-based cytotoxic chemotherapy for advanced or recurrent endometrial cancer?
A pertinent question that we should hopefully know the answer to relatively soon. KEYNOTE-775 did not address this question. However, the LEAP-001 trial, a phase 3 randomized, open-label, study is investigating and comparing the survival outcomes of Pembrolizumab and Lenvatinib vs chemotherapy (carb...
Do you treat an endometrial cancer that is microsatellite-stable but has a high TMB after progressing on platinum-based therapy with pembrolizumab?
Yes I would. Similarly, I would also treat a patient with advanced cervical cancer with Pembrolizumab. I have a patient with PDL1 negative, TMB-High squamous cell carcinoma of cervix. Submitted to insurance for coverage and she is approved for Carbo-Taxol-Bev-Pembro. It is absolutely worth a try and...
How does your approach to the primary treatment of glassy cell carcinoma of the cervix differ from the primary treatment of squamous cell or adenocarcinoma of the cervix?
No difference.
Given the negative results of GOG-0238 but the positive results of the RUBY trial, how do you manage isolated vaginal cuff recurrence of endometrial cancer?
I would favor definitive RT alone and reserve chemo plus IO for systemic or nodal relapse.