Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Do the results of the ConCerv and SHAPE trials alter how you might counsel a patient incidentally found to have ≤IB1 after simple hysterectomy?
The ConCerv and SHAPE trials have demonstrated that selected patients with low-risk, less than or equal to stage IB1 cervical cancers can be safely treated with simple, extrafascial hysterectomy with lymph node assessment. Given those findings, if a patient met the criteria for inclusion in the ConC...
Do the number of lymph nodes removed in a non-Stage IA/FIGO 1 endometrial cancer case, affect your decision for WPRT v. vaginal brachytherapy alone?
Yes, in some cases it does—for two reasons. If a patient has had an extensive negative node dissection, the risk of extravaginal pelvic failure is undoubtedly less and the risk of RT complications may also be greater than if the patient had hysterectomy only. These factors define the “therapeutic ga...
What is the biggest mistake people make when using IMRT to treat cervical cancer?
I can't say for sure what the biggest mistake people make is, but some common issues I see when reviewing others' contours are: Using insufficient margins around the vessels when contouring the nodal volume (CTV) Using insufficient planning margins around the vaginal cuff (postop) or cervical mass/u...
What is the role of parametrial and pelvic side wall boosts in the setting of volumetric brachytherapy for locally advanced cervical cancer treated with either 3DCRT or IMRT?
The rationale behind the parametrial/side wall boost could be one or both of below 1. Treating the parametrium 2. Boosting involved pelvic nodes If it's done for an additional boost dose to the involved nodes, then the nodes should be contoured and dosimetry should be done to ensure coverage of invo...
How would you approach the management of a patient with locally advanced cervical cancer as well as synchronous endometrial adenocarcinoma?
The short answer is--treat both malignancies with a therapeutic plan that addresses them both. While the question fails to provide the details necessary to navigate the particular situation, some guiding principles can be asserted. 1. Intensity of therapy should be proportionate to the more dangerou...
How do you sequence vaginal cuff brachytherapy with EBRT for post-op endometrial or cervical cases that require both modalities?
We do sequential without any break after EBRT
In a patient with a vaginal cuff recurrence from endometrial cancer not amenable to interstitial brachytherapy, how would you boost after 45Gy?
If not amenable to brachy which is unusual in our practice, we would use IMRT boost to 66 to 70 Gy.
Would you recommend systemic therapy in a patient with a history of Stage III high grade serous endometrial cancer s/p resection of a solitary pulmonary metastasis after a long disease free interval?
Systemic therapy should be advised in this patient with recurrent serous endometrial cancer after surgical resection of oligometastatic disease and a long disease free interval. Before advising a specific therapy, pathologic review by an expert gynecologic pathologist for both histologic confirmatio...
Would you offer adjuvant chemotherapy in addition to pelvic RT in a patient with fully resected pelvic recurrence of endometrial carcinoma?
For endometriod histology For nodal relapse, we do offer adjuvant chemotherapy, extrapolating from benefits seen in stage III disease, but not for isolated vaginal relapse.
Would you consider fertility-sparing management of stage IB1 cervical cancer using NACT followed by conization?
No, I would not consider neoadjuvant chemotherapy (NACT) and conization for this patient outside of a clinical trial. Two ongoing prospective clinical trials are currently evaluating NACT for fertility preservation in Stage I and II disease and may provide future clinical guidance on oncologic outco...