Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How would you approach treatment for centrally recurrent cervical SCC with positive margins after excision that was not exenteration?
We treat with concurrent chemo RT with EBRT plus brachy. Total dose of brachy is based on the extent to residual disease. For positive margin as above with non oncological resection, 65-70 Gy equivalent dose. Would get MRI of pelvis with vaginal gel to assess any residual disease.
How would you treat an isolated para-aortic node recurrence 1.5 years after receiving primary chemoradiation for locally advanced cervical cancer?
We treat with definitive chemo RT to pa region using IMRT (weekly cisplatinum with 45 in 25 to pa region and 55-57.5 Gy in 25# SIB to node). Small bowel and duodenum dose constraints (V55 < 5 cc and V55 < 1cc respectively).
What would be your treatment approach for a patient with a new PET positive para-aortic node 3 months following completion of definitive chemoradiation for locally advanced cervical cancer?
My approach would be to treat the entire para-aortic field (above the previous field, obviously) to approximately 45 Gy with conventional fractionation, followed by a boost to the PET positive node to get to a dose of 60 Gy or so, if possible, while respecting the relevant tolerances. If the volume ...
What dose fractionation would you use on a large retroperitoneal recurrence of cervical cancer that is extending to previously treated 5040cGy pelvis?
Favor starting with chemotherapy, and planning RT based on response to chemo as volume and dose can be adjusted based on response.
What palliative regimen do you use for intra-pelvic recurrence of cervical cancer after definitive chemoRT with T&O brachytherapy?
Based on performance status, expected survival, the time elapsed from previous RT, and volume to treat, have used quad shot to 24-30 in 12 to 15 fraction or salvage HDR interstitial to EQ2 dose of 40 Gy or so.
What HDR dosing would you use in the neoadjuvant setting of endometrial cancer?
This is our experience: I use 5 Gy x 3 to 4 fractions based on response with EBRT with EQ2 dose of around 65 Gy.Vargo et al., 25218303Iheagwara et al., PMID 30802615
For newly diagnosed advanced cervical cancer, how soon after periaortic lymph node evaluation do you start definitive chemoradiation treatment?
It depends on the evaluation method: PET scanning, limited node biopsies, lymph node dissection. In general, 4-6 weeks is a reasonable waiting period, if post-op course is uneventful. I would use IMRT to decrease small bowel and kidney toxicity. Dose, about 5000 cGy and boost with limited volumes to...
What is the role of uterine artery embolization (UAE) in patients with locally advanced cervical cancer with emergent bleeding that persists through vaginal packing?
With packing and starting urgent chemo RT, the need for embolization is very limited in our practice. That being said, data suggest if embolization is done, it doesn’t affect efficacy or complication risk of subsequent chemo RT.
Is there a role for progestin therapy to temporize bleeding from endometrial cancer in a patient with an active venous thromboembolism?
In the setting of a newly diagnosed DVT in an otherwise surgically appropriate patient with known endometrial cancer, I would still consider keeping with the standard strategy of proceeding with surgical staging. I would place a filter and proceed with minimally invasive approach, if feasible. Posto...
What is your adjuvant therapy approach for stage II endometrioid endometrial cancer?
For patients with stage II endometrioid endometrial cancer, there are several considerations for adjuvant treatment. I recommend using the NCCN guidelines to guide your patient's case when possible. If there is visible tumor involvement of the cervix prior to surgery, I will perform a radical hyster...