Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
When do you start a vaginal dilator after EBRT to the vaginal canal?
Although I have not reviewed the published data in a while, from my data review ~8 years ago and my own cumulative gynecologic specialty experience, I have fallen into the following paradigm: In the setting of standard EBRT or vaginal cuff brachy, for a patient, in reference to the use of a vaginal ...
What is your strategy to prevent and treat constipation in patients initiating or receiving opioids?
I am a radiation oncologist and palliative care physician.I teach: "the hand that writes the opioids, writes the laxatives - or else it does the disimpaction". Opioid induced constipation is very common, can cause physical and psychological discomfort, and have a major impact on quality of life. It ...
In your practice, what is your goal dose for boosting positive PA nodes in either the adjuvant or definitive treatment for cervical cancer?
The dose of RT is based on the risk of tumor recurrence tempered by normal tissue constraints. In general, known or suspected gross nodal disease is treated to 60 Gy; higher doses of 62-66 Gy may be used for large nodes that are not immediately adjacent to the duodenum, particularly if a portion of ...
With the addition of pembrolizumab following chemoradiation per KEYNOTE-A18, would you be less likely to treat the paraaortic chain prophylactically?
I would favor the same volume of RT with or without pembro. If there is an indication to treat PA nodal chain, would treat as per plan.
Is there a role for leucovorin in a patient who is 3 days post her most recent treatment dose of methotrexate for GTN, who is experiencing grade 3 mucositis?
I would give it, but it has not been shown to be effective. I just feel like I should do something.
What adjuvant treatment would you recommend for a patient with FIGO 2023 IIIB2 endometrioid endometrial adenocarcinoma (Grade 3, p53mut, MMR proficient), metastatic to the uterine serosa, bilateral ovaries, and anterior peritoneal reflection?
Chemotherapy followed by pelvic RT
What is your approach to cancer patients who inquire about alternative or complementary treatments?
It depends a little bit on what specifically they want to use, and if they are truly investigating alternative medicine or complementary medicine. For people seeking full alternative medicine without any conventional treatment, I tell them that a research study showed that people who pursued the alt...
For vaginal cuff recurrence of an endometrial cancer, when do you utilize a multichannel cylinder versus single channel cylinder if a patient has <5 mm residual disease after EBRT?
If disease is confined to one wall, favor MC applicator as I treat vaginal wall thickness for side involved while surface on other side. MC allows that flexibility.Here is the link to our publicationGebhardt et al., PMID 29929925
For an elderly woman with a platinum-resistant recurrence of a high-grade serous ovarian cancer who has been rendered NED surgically, is observation a reasonable approach?
Based on her age, performance status, and goals of care, it is certainly reasonable to discuss all options with patients. With her being platinum resistant, I would counsel on prognosis and the need to consider quality of life. With the need for balance between QoL and OS, waiting until there is a m...
How do you manage patients with germline BRCA mutations who have STIC lesions found at the time of risk-reducing BSO?
How do you manage patients with germline BRCA mutations who have STIC lesions found at the time of risk-reducing BSO?Most experts agree these are worrisome lesions, likely precursors to high-grade serous carcinoma (HGSC). It is also biologically plausible that the presence of serous tubal intraepith...