Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How long of a delay are you willing to accept for vaginal cuff brachytherapy either as primary therapy or as boost?
The absolute benefit of vaginal cuff HDR boost is small and 6 months delay would negate any such benefit.
How would you approach an adolescent patient with stage IIIC serous borderline tumor, s/p fertility sparing surgical staging with unilateral salpingo-oophorectromy, who presents with an enlarging contralateral ovarian mass and additional pelvic disease on imaging?
I would attempt cystectomy and debulking of pelvic disease. If ovarian salvage is not possible, then I would prioritize saving the uterus. If final pathology continued to show borderline tumor, then I would observe. If low-grade serous or high grade serous on final pathology, then I would treat with...
What normal tissue dose constraints do you use when delivering up to 3 cycles of the palliative quad shot regimen for gynecologic pelvic malignancies?
I don’t follow fixed dose constraints but adjust based on the volume of disease and the volume to treat.
How do you manage insomnia in cancer patients that is refractory to traditional sleep aides?
Insomnia and other sleep disturbances are very common in individuals diagnosed with cancer, and it is often helpful for patients to hear this. A good history of other contributors to sleep disturbance can be helpful as well. Often, depression, anxiety, and pain, as well as other stimulant medication...
How would you manage a patient with synchronous breast and ovarian cancer, s/p neoadjuvant chemotherapy and surgery for ER+/HER2- breast cancer and found to have an ER+ ovarian cancer nodal metastases at TAH/BSO?
I usually treat my triple negative breast cancer patients (whether or not there's a deleterious mutation in the homologous recombination repair pathway, e.g. BRCA1 or BRCA2) with neoadjuvant docetaxel + carboplatin. The addition of carboplatin to taxane-based neoadjuvant chemotherapy regimens was ev...
In a patient with serous ovarian adenocarcinoma who presents with SBO due to focal involvement of the small bowel, but who has other extensive metastases and cannot get chemotherapy due to bone marrow compromise, would you recommend palliative RT in addition to venting G-tube placement?
Assuming she is expected to be platinum-sensitive and otherwise a good surgical candidate, then I would recommend an ileostomy and G-tube. I would avoid RT.
Would you offer radiation therapy for ovarian remnant syndrome?
I have treated a few times with mixed results to a dose of around 20 Gy.
What is the preferred second line agent for a woman with metastatic vulvar cancer who has progressed on carboplatin/paclitaxel?
There is not one preferred second line agent for women with metastatic vulvar cancer who have progressed on carboplatin/paclitaxel. My preference is to put those patients on clinical trial, if possible. Next generation sequencing of the tumor could guide placement into a trial (such as MATCH or TAPU...
Do you recommend concurrent cisplatin and gemcitabine with radiotherapy for unresectable vulvar cancer, as described in GOG-279?
We are still doing weekly cisplatinum with a higher dose of RT as there is concern about additional morbidity with the addition of gemzar. Richman et al., PMID 32981696
What brachytherapy dose/fractionation should be used for small cell carinoma of the cervix?
I treat a small cell carcinoma of the cervix the same as a squamous cell or adenocarcinoma as far as the RT portion of treatment. I would give 45 Gy pelvic RT (I would treat PA if involved or if there are positive pelvic nodes). I would give SIB to positive nodes to 55 Gy (2.2 Gy/fx) in the pelvis a...