Endometrial Cancer   

What do you think is the role of radiation for this patient and how should it be timed?

Do you offer observation for POLE mutated tumors?

Would you consider the addition of carboplatin/paclitaxel + dostarlimab to radiation as opposed to radiation alone?

Re-staging is otherwise negative; patient's disease has FIGO grade 1 endometroid histology

For a woman with complete resection of serous intraepithelial carcinoma of the endometrium, would you recommend adjuvant radiation or chemotherapy? Wh...

In the PORTEC LVSI grading system, 3 or more vessel are classified as extensive LVSI, while the FIGO 2023 Endometrial Cancer staging they reference WH...

Would you consider VBT alone vs EBRT and/or offer chemo? This is a female in her late 60s with FIGO 2023 IIB disease given substantial LVSI+ (>5 v...

What would you recommend for a patient in their 60s with stage IB grade 1 endometrial cancer without LVSI? How would this differ for a patient with st...

Do you proceed with sequential, concurrent, or sandwich treatment?

The patient also declines any brachytherapy treatment. 

Her primary disease is too large for any brachytherapy; if substantial residual disease remains, how would you approach external beam boost?

How will you translate treatment recommendations from older studies to the new staging system?

A patient in her 70s initially underwent TAHBSO + LNB with Stage I, G1 cancer, No LVSI. 18 months later with very small mucosal recurrence (5mm). HDR ...

Does the presence of parametrial or cervical involvement impact your decision? How do you sequence treatment modalities?

This case involves an impressive ‘high volume’ vaginal recurrence and patient was not originally planned for adjuvant therapy. Concerned t...

Would the extent of nodal involvement sway you one way or another (i.e., a micromet in a single sentinel node)?

Do you wait until chemotherapy completion, interdigitate between cycles 1-2 only when feasible, or between any cycle of chemotherapy? What factors wo...

At our institution we often give 5.5 Gy x 4 fractions. There really does not appear to be a general consensus regarding timing. Interested in what oth...

Would there be a survival advantage to pelvis RT with deep myometrial invasion, LVSI and ITC?

What instructions do you give your radiation therapists - do you rely on OAR identification (ie. bladder and rectum filling) or soft tissue match to t...

Do you give cuff and chemo or pelvic CRT or chemo alone?

Would you offer pelvic RT or intracavitary brachytherapy?

Considering the ASTRO guidelines recommend against systemic therapy for patients with FIGO stage I-II endometrioid adenocarcinoma, would your recommen...

Please comment on toxicity profiles and the insufficient evidence regarding overall survival.

The patient is >40 yo with Lynch syndrome and a history of endometrial hyperplasia status post R0 TAH/BSO with SLNBx for a 5.2 cm, grade 3 adenocar...

The recurrence is mucosal and inferior to the prior field. 

Surgery remains an option. Given favorable response, would you recommend pre-op or definitive RT +/- chemo?

If you do not use the PORTEC-3 regimen for p53 mutated IA endometrial cancer, what specific protocol or combination of chemotherapy and radiation ther...

How do you take into account pathologic factors like %clear cell histology, myometrial invasion, and LVSI?  

Would you recommend if there is only one uterine factor or do you typically require multiple to make this recommendation? 

Please consider this National Cancer Database (NCDB) and Surveillance, Epidemiology, and End Results Program (SEER) registry study (Barrington et al.,...

Female in her 60s who had presented originally with well-differentiated endometrioid adeno clinically and radiographically involving bilateral paramet...

How does your approach differ for patients under age 60, between 60-70, and over age 70?

How does histology and/or molecular testing change your approach? How does the length of the disease free interval change your approach?

This patient previously received hysterectomy with adjuvant vaginal cuff brachytherapy without pelvic RT. Colonoscopy demonstrated invasive disease, b...

This endometrial cancer was a fortuitous finding following vaginal hysterectomy.

Is there any particular reason to include or not include this in the treatment volumes?

Would you recommend whole pelvis as well as vaginal cuff brachytherapy?

VC brachy, pelvic RT, +/- chemo?  Does your management change if it is confined to the endometrium without myometrium invasion or if it is only ...

Would involvement of the PA nodes be an indication?

EBRT vs VB? She technically meets PORTEC2, but also meets GOG99 and GOG249 (for pelvic RT) and PORTEC4. NCCN recommends for IB grade 1 vaginal brachyt...

Is there any indication for ENI in early stage disease or in advanced stages, without pathologic confirmation or PET positivity or CT size criteria?

The patient was initially observed after radical hysterectomy due to young age, FIGO IA grade 2 disease. The patient had isolated, biopsy-proven vagi...

In women receiving HDR intracavitary brachytherapy to treat the vaginal cuff, how do you overcome the challenge of excess lateral vaginal tissue ("dog...

Planning carboplatin/taxol/trastuzumab. Cervical stromal invasion on path. Looking for pelvic vs brachy and timing with chemotherapy.

Tumor felt to be technically unresectable due to extensive cervical/parametrial involvement. ER/PR and HER2 testing are pending.

Tumor traverses the myometrium to focally involve the serosa; 1/6 sentinels with ITC and the rest negative. 

Pt is 73yo, Grade 1, 81% invasion, MELF like features, foci of LVSI, and 47 ITCs identified.

HER2 status is pending

Pt is 69yo, tumor 1.4cm, negative LVSI, ER/PR +

Does not technically meet high intermediate risk criteria.

In the unfortunate setting where you cannot get an underinsured patient whose policy does not cover radiotherapy started on treatment without guarante...

Would you offer EBRT alone or EBRT with vaginal cuff brachytherapy after surgery and chemotherapy for stage III (T3N0) carcinosarcoma of the uterus? ...

Ie for patients who are inoperable due to comorbidities?

For a patient with good response to immunotherapy (unable to receive chemotherapy due to kidney function, comorbidities) where previously avid LN have...

http://abstracts.asco.org/199/AbstView_199_180760.html http://abstracts.asco.org/199/AbstView_199_187537.html  

Does the GOG 249 abstract guide you one way or the other?

How do you counsel a pre-menopausal female with endometrioid cancer desiring definitive RT with egg harvesting and IVF for fertility preservation inst...

Insurance authorization for protons is pending, but if the patient cannot have protons would you treat with standard fractionation to ~70Gy or conside...

NCCN recommends brachytherapy plus or minus pelvic RT for surgically staged Grade 1, Stage II patients, but these originally staged IIB patients were ...

Would you consider EBRT or brachytherapy boost to the nodes? what dose would you recommend?

For the management of stage II endometrial cancer, NCCN says pelvic RT and/or vaginal brachytherapy.   Do you ever add vaginal cuff boost to pelv...

MRI and cervical biopsy are negative for cervical involvement 

Would estrogen cream be helpful in this scenario?

are there any positive or negative synergies from combined megestrol/RT treatment?

At what point would you introduce the discussion of weight management, whether for risk reduction or overall health?

The NCCN recommends either systemic therapy + brachytherapy or pelvic RT + brachy or brachy alone or observation. How do you decide among these option...

The disease involving the endocervix was felt to be separate and appeared like a drop metastases

Current NCCN guidelines suggest that vaginal brachytherapy is optional, and there may be concern for over-treatment locally given competing risk of di...

In what situations is it appropriate to offer observation (rather than VBT) to patients with stage II endometrial carcinoma who have had a radical hys...

And if so, in which situations do you offer differing doses?

For example, in an otherwise intermediate risk localized endometrial cancer (Grade 2, FIGO IB)?

What clinicopathologic features do you typically consider?

If the post-operative simulation films reveal a significant lymphocele secondary to pelvic lymph node sampling, is it imperative that the entire lymph...

The gyn oncs at my institution sometimes will not perform lymphadenectomy if biopsy indicates low risk disease. Would LVSI as sole adverse risk factor...

What exactly do you contour and what is your dose constraint to that volume?

Does using something like a vienna applicator allow you to avoid dose escalation with more external beam? How do you recommend doing a classic pa...

Some classic references recommend the coverage of the entirety of the sacrum but the volume delineation guidelines for both seem to only cover the mos...

Does hydroureter and leg edema alter your opinion?

Brachytherapy, EBRT or both and what is the best dose?