Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What are your top takeaways from SGO 2024?
SGO 2024 was a great meeting with many excellent presentations. We are truly “moving the needle together”. The following presentations are each practice changing. Duska et al., PMID 38521086: Pembrolizumab plus chemoradiotherapy for high-risk locally advanced cervical cancer: randomized, double-bli...
What are your top takeaways in Gyn Cancers from ASCO 2024?
ASCO 2024 was a quiet year for the gynecological cancer community without too many fireworks. For the radiation oncologists, there were very few positive studies. I will highlight a few important ones 1. Oral abstract #5504 was on “Adjuvant chemotherapy following concurrent chemoradiation (CRT) in p...
What techniques do you use to address fertility preservation in young female patients being treated with chemoradiation therapy for cancer in the pelvis?
The most important aspect of a fertility preservation strategy is to think of it early on in the discussions with your patient. Many medical centers now have a clinic or center to which patients can be referred and seen within several days. They are experts at explaining the options and outcomes wit...
What is the role of EBRT/brachytherapy (as an addition to chemotherapy) in the adjuvant management of optimally debulked stage IV uterine serous carcinoma?
There is no prospective study in this setting and based on limited retrospective data we do consider adjuvant RT for optimally debulked (meaning no macroscopic disease left behind after surgery) disease. We do consider pre surgery bulk of disease in decision making and would recommend RT for those w...
In what circumstances would you offer adjuvant radiation after resection of vulvar mucosal melanoma?
If immunotherapy is indicated, I would start that right away. I would treat for positive margins or melanoma in situ at the margins using 30/5-6 fx twice a week. Would treat the tumor bed with a 10-15mm margin. I wouldn't treat the groins. Would also recommend a thorough GYN exam in the OR if not d...
How would you treat a patient who has an inguinal p16+ SCC lymph node of unknown origin?
We have published a 60% 5yr OS for SCCa of unknown primary. The two most likely primary sites are anal cancer and vulvar cancer. Please see my previous posts for anal cancer doses. I would treat this patient to the ipislateral inguinal external and common iliac nodes. Once could consider treatment o...
What toxicities related to mirvetuximab have you seen in your patients and how have you managed them?
The most common side effects we experience are ocular and have been relatively well controlled with ocular mitigation strategies and expectation discussions prior to starting. The most severe adverse event we have experienced is pneumonitis which needs to be recognized with prompt action. Unfortuna...
How do you approach adjuvant therapy for patients with advanced ovarian cancer who undergo interval debulking surgery following six cycles of neoadjuvant chemotherapy?
If viable tumor at the time of surgery and patient has acceptable performance status then I would treat 2-3 more cycles of chemo followed by maintenance therapy. However, if no viable tumor at the time of surgery then I would forego IV chemotherapy and start maintenance postoperatively depending on ...
How would you treat a recurrent, metastatic invasive Paget's disease of the vulva?
Just to clarify, this is a recurrence within the radiated groin, and that recurrent groin node has been resected so there is no gross disease currently? Any treatment for metastatic, recurrent invasive vulvar Paget’s disease will be non-curative/palliative, so at this post, if there is no gross dis...
Would you treat the whole bladder with a cervical cancer that is invading the bladder?
The short answer is no. The posterior wall of the bladder is generally what will be involved and will be in the PTV anyway. This is how I would approach planning: I would fuse the MR T2 sequence with my planning CT, and use the cystoscopy report as well to ensure that the involved portion of the bl...