Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What is your preferred adjuvant chemotherapy regimen after a completely resected stage IIIB Granulosa Cell tumor of the ovary?
Recommendation: Patients undergoing surgery with complete resection of tumor for an ovarian granulosa cell tumor (GCT) may be offered systemic chemotherapy or observation. If chemotherapy is offered, I prefer a combination of carboplatin and paclitaxel. Background: GCT of the ovary is the most commo...
For patients with ovarian cancer, do you order folate receptor-alpha testing at initial diagnosis, first recurrence, or first instance of platinum resistance?
I usually order at initial diagnosis because: We have tumor specimen to test on at the initial dx Most advanced ovarian cancer will recur initially as platinum-sensitive. But eventually, most of the patients will become platinum-resistant I have not seen convincing data that folate receptor changes...
What would you offer a patient with MSI-high metastatic endometrial cancer after disease progression on pembrolizumab?
It appears that it has been two years since the last platinum therapy (progressed after 1 year, then on immunotherapy for one year) so it's very reasonable to consider the use of platinum-based chemotherapy again, an option could include platinum + taxane + bevacizumab to add a targeted therapy to t...
How would you manage a recurrent cervical cancer previously treated with vaginal cuff brachytherapy and has had a complete response to chemo-immunotherapy?
Ling et al., PMID 30600093 -The paper gives our philosophy in this scenario. The total dose is the function of dose to target and cumulative dose to rectum and bladder. To be able to give a higher dose with brachy, generally would favor around 30.6 Gy with EBRT and then limit the last 14.4 Gy to the...
How would you treat a p16+ squamous cell carcinoma confined in the recto-vaginal septum with no suspicious adenopathy on PET or MRI?
Early vaginal or anal cancer still has relatively high rates of lymph node involvement. In vaginal cancer, T1 lesions have lymph node involvement rates of 5 - 15%. In anal cancer, T1 lesions have a higher rate of 5 - 50%. If there are no mucosal changes then it is possible this is an in-transit LN f...
How would you deliver/time radiation for a patient with IIIC1 serous endometrial cancer who is HER2+?
Stage III (particularly IIIC) and serous histology are both risk factors for distant failure. In combination, the patient is at an even higher risk. Therefore, I would prioritize getting in all cycles of chemotherapy to maximize distant control; generally, this would comprise 6 cycles of carboplatin...
How would you manage a POLE mutated, p53 abnormal IA myoinvasive carcinosarcoma of the endometrium with no LVSI?
I would not change the management of IB and above non-endometrioid histology based on mutation analysis as almost all data is for endometrioid histology.
Do you have any normal tissue constraints for endometrial cancer patients receiving EBRT and vaginal cuff brachytherapy?
We use following constraints for EBRT35 Gy to less than 35% of bowel bagRectum 40 Gy less tha 40-60% Bladder 40 Gy less than 40-60%Bone marrow ( pelvic bone) V20 less than 75% Femoral heads V35 less than 5%for brachy as adjuvant we give 5 Gy x2 to thickness of vaginaSince total dose loss limit and p...
What approach have you found works best in treating persistent acute radiation proctitis in patients undergoing pelvic EBRT?
Obviously, this is an important question, though I'm a little unclear on the meaning of "persistent acute" radiation proctitis. Though I am not certain, I believe @Dr. First Last's answer applies more to chronic (or at least sub-acute) radiation proctitis. As for the more traditionally "acute" radia...
How do you approach boosting a vaginal cuff recurrence of cervical cancer with brachytherapy that is tethered to small bowel?
Tough case. Controlling cancer is important. MRI guided brachy and making sure GTV is adequately covered even if bowel wall gets that dose. Warn the patient about bowel obstruction and the need to bypass in future.