Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What factors impact your decision to include bevacizumab with primary chemotherapy for patients with BRCA+ or HRD+ ovarian cancer?
The decision for bev isn’t based on HRD or BRCA biomarkers – it is based on clinical factors and provider preference. Bev is approved for all epithelial ovarian cancer, advanced stage with and to follow platinum based chemotherapy based on a clinically and statistically significant improvement in PF...
Can non-16/18 HPV types cause ASCUS and squamous cervical metaplasia on biopsy within 3 months of acquisition, or would it take longer?
It isn't clear that HPV causes ASCUS. I'm not sure how to interpret "squamous metaplasia" as opposed to dysplasia, but certainly many HPV types other than 16 and 18 cause cervical dysplasia, and probably can do so within 3 months of acquisition. However, I would be cautious in telling a patient that...
In light of the improved outcomes seen in patients receiving IO +/- olaparib, what role, if any, do you think pelvic radiation still plays in the management of patients with advanced endometrial cancer?
The study included a wide spectrum of patients including advance stage with residual disease or recurrent with or without residual disease. Prior RT when indicated was allowed and about 40% had RT as part of care.
How have you incorporated mirvetuximab into the treatment of platinum-resistant ovarian cancer?
This question is going to be increasingly important in the current landscape of ovarian cancer management. I have prioritized early ordering of biomarker testing so that I have the test profiles available at recurrence, particularly in the platinum-resistant standpoint.I find that toxicity, patient ...
What is the maximum interval you would consider delivering adjuvant radiation therapy for endometrial cancer?
The data has not been evaluated prospectively but retrospective studies suggest RT delay beyond 8-9 weeks after surgery decreases efficacy of treatment. That being said, have treated high risk patients up until 16 weeks but explained the pros and cons of treatment.https://www.ncbi.nlm.nih.gov/pubmed...
In patients with recurrent endometrial carcinoma, how do you decide when to offer Carboplatin/Paclitaxel +/- pembrolizumab or dostarlimab (NRG-GY018/RUBY) versus Lenvatinib/Pembrolizumab (KEYNOTE-775)?
I take into account prior therapy regimen in the upfront setting, time to recurrence, burden of disease for pMMR recurrence, and of course, patient characteristics--can they tolerate chemotherapy (again) or how concerned I am about lenvatinib toxicity in said patient? If they have not had chemothera...
What dose and OAR constraints do you use for boost with IMRT or SBRT when a patient with cancer of the cervix is not a candidate for brachytherapy?
Concurrent chemoradiotherapy plus brachytherapy boost (intracavitary or interstitial) is the standard of care in patients with locally advanced cervical cancer. In light of published data suggesting inferior survival if brachytherapy is omitted from definitive treatment, we do not recommend utilizin...
Would you add a brachytheray boost to a locally advanced cervical cancer after surgical resection and pelvic RT?
In general, a brachytherapy boost following external radiation is not standard when treating women for locally advanced cervical cancer post hysterectomy. Neither of the 2 major adjuvant GOG trials (92 and 109) allowed a brachytherapy boost, and even the currently open GOG trial, GOG 263, does not i...
Would you recommend surgery or stereotactic radiation therapy for a young woman with high-grade serous ovarian cancer presenting with a pelvic LN oligometastasis following maintenance therapy?
Like OM, the principle for other cancer favors SBRT as has excellent local control and low morbidity Donovan et al., PMID 38869888
Do you recommend Hyaluronic Acid Therapy for vaginal dryness in female patients post pelvic RT?
I do not. Not saying you shouldn’t though. I recommend coconut oil which can be used with a vaginal dilator, for intercourse or purely for hydration. If ineffective, I will refer back to gynecology. There may be a role for topical estrogen depending on the cancer histology.