Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
In mismatch repair deficient recurrent endometrial cancer eligible for single agent PD-1 inhibitor, do you prefer pembrolizumab or dostarlimab and why?
From KEYNOTE-158, single agent Pembrolizumab (anti-PD1) in dMMR recurrent endometrial cancer patients (N=79), ORR 48% (14% CR and 34% PR). Median PFS was 13.1 months. In this study, adverse events happened in 76% of patients. 12% had G3-4 toxicity. 7% discontinued for toxicities. 7% had G3-4 immunot...
How do you manage a patient with an endocervical cancer indeterminate for endometrial or cervical origin status post TAH/BSO and sentinel node biopsy?
P16 and CEA positivity (although focal) favor cervical cancer. Can also do high risk HPV and p53 as suggested. Either way, the patient looks like they had a simple hysterectomy done and would favor EBRT plus brachy (would consider adding weekly cisplatinum if the overall picture is cervical).
For patients with endometrial cancer, should tumor size be included as a risk factor for recurrence?
Tumor size is not currently used in staging for endometrial cancer.There have been some retrospective studies that suggest a higher rate of local recurrence and recurrence-free survival in patients with endometrial cancer and a larger tumor size (>2-2.5 cm). (Sozzi et al., PMID 29489475) (Han et al....
Do you add chemotherapy to pelvic radiation and brachytherapy for an isolated vaginal cuff recurrence of endometrial cancer?
We offer concurrent cisplatinum with EBRT to high grade or bulky vaginal diseasehttps://www.ncbi.nlm.nih.gov/pubmed/25241996
What treatment would you offer a patient with metastatic cervical cancer to the supraclavicular nodes with a complete clinical response in her nodes, but a 3 cm residual in the cervix?
Patients with stage IV disease because of s/c node only, we treat with definitive intent covering all pre chemo disease with combination of EBRT and brachy, based on limited series for WSU and Korea showing a subset has long disease free interval with potential for cure.
What adjuvant therapy would you offer a fully resected isolated pelvic peritoneal recurrence of a uterine serous carcinoma?
Although the recurrence appears to be isolated, peritoneal recurrence of serous endometrial carcinoma suggests more than localized disease, thus systemic therapy is appropriate. Because the most common site of another recurrence is in the vicinity of the resected metastasis, stereotactic local radia...
What starting dose of lenvatinib are you ultilizing in recurrent endometrial cancer patients initiating lenvatinib/pembro?
I start with 20 mg daily. I base this on the recent study by Makker and colleagues
How would you manage recurrent endometrial cancer limited to pelvic and inguinal nodes in a patient with no previous radiation?
If it is a delayed recurrence, we usually treat nodal regions only (going one level above involvement) with IMRT and concurrent weekly cisplatinum chemotherapy with SIB boost to node followed by possible adjuvant chemo.
When do you include the mesorectum for definitive cervical cancer patients getting concurrent chemoradiation followed by brachy?
I would also include it if there is direction invasion into the mesorectum or EMVI.
How would you treat a stage IA mixed carcinosarcoma/neuroendocrine tumor of the endometrium, negative LNs?
This is definitely an interesting question. Given the high-risk histology, I would want to ensure that a gynecologic pathologist has confirmed the histologic diagnosis as well as have imaging (either CT chest/abdomen/pelvis or PETCT skull base to mid-thigh) to ensure there is truly no extra uterine ...