Precision to Palliation: Contemporary Management of Advanced Gynecologic Cancers in a Multidisciplinary Framework-Recording

Video Transcription

Video Summary

The IGCS–AGOI joint webinar, “Precision to Palliation: Contemporary Management of Advanced Gynaec Cancers,” highlighted how multidisciplinary care spans molecularly guided treatment through palliative frameworks. Leaders from IGCS and AGOI emphasized the strategic partnership, global training/mentoring goals, and practical resources such as the IGCS Education 360 portal, surgical film library, early-career network, and upcoming IGCS meeting in Montreal.<br /><br />A multidisciplinary tumor board format was used with Indian cancer centers presenting complex cases to an international expert panel. The first case was advanced endometrioid endometrial cancer (FIGO 2023 stage IIIC1) with pelvic nodal disease and dual molecular features (MMR deficiency with an initial report of p53 mutation). Discussion focused on high-risk factors (stage, nodal and parametrial involvement, molecular profile) and the role of neoadjuvant systemic therapy when upfront complete resection is uncertain. Panelists favored chemotherapy plus immunotherapy (ideally pembrolizumab or dostarlimab), acknowledging real-world access and cost constraints (e.g., use of nivolumab). Response assessment strategies included CA-125 trends and repeat MRI (with PET-CT as available). After good response, surgery (radical hysterectomy with selective node removal) was performed, followed by debate on adjuvant radiotherapy and brachytherapy; many favored “treating all out” with combined systemic therapy and pelvic RT, while noting evidence gaps and toxicity considerations.<br /><br />A second case discussed locally advanced cervical cancer (stage IIB). Experts reviewed staging (MRI and PET-CT where available), limited indications for cystoscopy, lack of role for primary surgery or node debulking, standard concurrent chemoradiation (weekly cisplatin) with IG-IMRT and image-guided adaptive brachytherapy, and evolving interest in induction chemotherapy (INTERLACE) and immunotherapy primarily for higher-stage disease.<br /><br />The session concluded with an IGCS overview of membership growth, elections, training programs, research initiatives, and collaborative opportunities.

Keywords

IGCS

AGOI

precision oncology

palliative care

advanced gynecologic cancers

multidisciplinary tumor board

endometrial cancer FIGO IIIC1

MMR deficiency

p53 mutation

neoadjuvant chemotherapy

immunotherapy pembrolizumab

adjuvant pelvic radiotherapy

locally advanced cervical cancer stage IIB

concurrent chemoradiation with brachytherapy