Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How does sarcomatous overgrowth in a uterine carcinosarcoma change your management of adjuvant therapies?
I tend to treat carcinosarcomas as high-risk endometrial cancers, with carboplatin/paclitaxel adjuvant chemotherapy, +/- vaginal cuff brachytherapy for early-stage disease. Adjuvant radiation for early-stage disease is also a consideration, as carcinosarcomas may have some improvement in local contr...
What is your institutional protocol for an incidental finding of an adnexal cyst on CT simulation for cervical cancer?
It is not common to have this finding. A combination of PET CT and MRI confirms the benign etiology of these cysts and can be ignored for cervical cancer management.
For a recurrent, MSI-H endometrial cancer, do you usually treat with Pembrolizumab alone or in combination with Lenvatinib?
Alone.
Would the presence of multifocal LVSI change your adjuvant treatment recommendation for a surgically staged IA dedifferentiated endometrial carcinoma?
Dedifferentiated is considered a high-grade lesion. There is admittedly low quality evidence on optimal management given lower incidence.I would recommend treatment with vaginal brachytherapy and very much offer chemotherapy. Would prefer vaginal brachytherapy, given the patient was surgically stage...
How does number of ITC influence your approach to adjuvant RT for a surgically staged 1B endometrial cancer meeting HIR criteria?
Management of ITC only in the setting of SNLN is not defined well. We know ITC has a much better prognosis than micromets and macromets. We also know that even with ITC after SNLN bx only, there is risk of additional residual nodal disease left behind which may need to be addressed. What we don’t k...
Would you offer consolidative radiation for oligometastatic uterine serous CA s/p surgery and chemotherapy with complete response?
Usually not unless pelvis only confined disease at presentation or microscopic omental disease removed at surgery.
What are indications to add WPRT +/- PA field to chemotherapy for uterine serous carcinoma?
There is variation in practice. After adequate surgical staging, our approach: Stage 1A brachytherapy alone. Stage IB and above, EBRT. If node negative, treat pelvic including entire common iliac. If pelvis node positive and PA node dissected same as above, up to common iliac. If pelvis is posit...
How do you approach a medically inoperable patient with clinically stage 2 grade 1 endometrioid endometrial carcinoma with heavy vaginal bleeding that is refractory to EBRT and requiring inpatient management with transfusions?
Tough case that requires some individualized care- I’d favor brachy if not resectable.
What type of DVT/PE prophylaxis do you employ for an outpatient cervical brachytherapy?
We don’t use anything for outpatient HDR ICBT for cervical cancer.
Is there a difference in survival or disease response between patients with recurrence free interval ≥1 vs <1 year from platinum-based cytotoxic therapy who are treated with pembrolizumab + lenvatinib?
As presented by Dr. Columbo at ESMO 2021, the OS favored len/pem with an HR of 0.65 (0.52-0.81) in pMMR pts with a PFI <12 mo while the HR was 0.75 (0.36-1.58) in those with a PFI >12 mo.