Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How would you manage mild SUV uptake at a 3 month PET/CT scan post chemoRT scan for a SCC of the cervix?
Typically at our institution, we would decide the next steps based on her exam findings. If there is concern for residual disease, we would either biopsy or see the patient back in a short period of time for a repeat exam. If there is nothing convincing to biopsy, we would likely repeat the PET/CT i...
How has the virtual aspect of tumor boards impacted their educational quality in the Covid-19 era?
In my experience, tumor boards serve 2 purposes. Firstly, they are designed to bring multiple specialists and cancer providers together in real-time to facilitate patient care. Secondly, they help educate the various disciplines based on a robust interaction. Virtual conferences are complicated by d...
How does your approach to low-risk gestational trophoblastic neoplasia differ for patients whose hCG levels plateau following initial single agent systemic therapy vs those who have a good initial response and then plateau?
For patients with low risk GTN whose hCG values plateau over a two-week interval, concerns arise about chemoresistance. Unfortunately, there is no consensus or clear guideline in terms of determining chemoresistance and when to switch therapy. I don't approach the two clinical scenarios presented he...
How do you boost patients with IVA cervical cancer who present with a large fistula that worsens during chemoradiation?
Preferred is interstitial brachy with our dose of 5.5 to 6 Gy x 5 in BID fractionation. Either MRI pre brachy with CT-based planning with applicator or MRI-based planning if can use hybrid applicator.
Do you give adjuvant RT to vulva in a patients with node positive vulvar cancer and no high risk features for vulvar recurrence?
There is variation in practice. I tend to treat primary also along with nodal volume as long term data shows a 25- 35% risk of LR and a low 65% salvage rate. Data unknown is how much would RT reduce this and if these are true recurrences or new primary. Te Grootenhuis et al., PMID 26428940
How would you approach a vulvar cancer with para-aortic and pelvic nodes?
I have treated a few patients with curative intent if ECOG 0-1. Especially if HPV positive. Below is the link to outcome for anal cancer with pa node involvement.Holliday et al., PMID 29907489
For adjuvant radiation decision making purposes, how is the "Lower Uterine Segment" (LUS) defined?
We have always used the pathologist's description of LUS (fundus, body, LUS, and cervix). That being said, I don’t use LUS as risk factor for deciding adjuvant treatment except in borderline cases where may lean towards brachytherapy if otherwise a candidate for observation.
What adjuvant radiation modality would you select for a grade 2 endometrial cancer with small nodule in the fallopian tube?
She would get chemotherapy for stage IIIA disease. For RT, in the past, used to offer EBRT after chemotherapy but now, if surgically staged with nodal assessment, would favor brachy alone.
How do you manage rectal or bowel perforation from interstitial brachytherapy needles?
One additional step I take other than the one highlighted is at the time of CT simulation if I notice that, I would pull those needles out either completely or to the point they are not into the wall of OARs.
What are your top takeaways in Gynecologic Cancers from ASCO 2022?
1. ATHENA (LBA5500)- Consistent efficacy signal with PARPi maintenance therapy in the front line- Another potential option for our patients with greater dosing flexibility- The BICR PFS difference in the HRP population really caught my attention. Nearly a 6 month improvement with median PFS in the r...