Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What features would push you towards re-operation for completion staging vs observation for a premenopausal woman with stage II borderline tumor of the ovary with capsule rupture and no other evidence of gross residual disease?
I would only reoperate if there were a survival benefit, symptomatic benefit, or change in treatment regimen. From the description, it doesn't seem like this meets any of those criteria.
What resources/ancillary staff do you utilize for school re-entry after cancer treatment to decrease anxiety, improve self-confidence, and support emotional functioning?
Facilitating school re-entry for children and adolescents undergoing cancer treatment is an important component of comprehensive care. Maintaining engagement in school can help preserve a sense of normalcy and mitigate feelings of isolation and loneliness. However, the transition back to school may ...
Are you altering your use of immune checkpoint inhibitors given the risk of immune-related pneumonitis and the COVID-19 outbreak?
The management of advanced cancer patients has gotten even more complex with the COVID-19 pandemic. In general, providers are trying to keep patients away from the hospital/clinic as much as possible, and avoiding regimens with greater toxicity if there are suitable less toxic alternatives. Whether ...
What is the best treatment for a medically inoperable endometrial adenocarcinoma of the uterus FIGO 1, grade 1, type 1?
I would get a pelvic MRI to assess tumor size and myometrial involvement. If small volume (2 cm or smaller) with superficial invasion then use brachy alone, otherwise EBRT plus brachy. The type of brachy is based on uterine width: If the width is less than 5 cm: single tandem and cylinder. Otherwise...
What is your approach to uterine perforation during the time of brachytherapy implant for cervical cancer?
First off, I think uterine perforations occur a lot more frequently and easily than we previously accounted for. I learned how to perform brachytherapy using purely orthogonal X-rays, with dosing and dwell position times based on measured distances from the applicators, and all of the focus was plac...
In light of the SHAPE trial results, how would you manage a patient with an incidentally diagnosed FIGO IA1 cervical cancer after simple extrafascial hysterectomy/BSO?
Without question, I would recommend that this patient receive pelvic RT and probably cuff brachytherapy as well. The SHAPE trial (NCT01658930) enrolled "low risk" patients, but they allowed LVSI patients into the trial, even though this is a high risk feature for local recurrence. There were approxi...
What are the current official guidelines regarding managing patients during COVID-19?
Here are some guidelines and FAQ from professional societies: NCCN: https://www.nccn.org/covid-19/default.aspx ASTRO FAQ: https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-Information/COVID-19-FAQs ASCO Coronavirus Resources: https://www.asco.org/asco-coronavirus-information
What is your approach to recurrent metastatic high-grade uterine carcinosarcoma with rhabdomyoblastic differentiation?
Carcinosarcomas (even with rhabdomyoblastic differentiation) are still considered to be derived from endometrial tissue. I would treat it as endometrial cancer and not as uterine or soft tissue sarcoma.
How would you approach adjuvant therapy for a fully resected vulvar carcinoma with a single positive lymph node?
There is not a simple answer to this question. In most cases, omitting adjuvant therapy is appropriate, but in certain cases, adjuvant radiation therapy + chemotherapy is advised, even in the presence of only a single positive lymph node. It has been over 30 years since Homesley and co-workers’ 1986...
How does positive peritoneal washings factor into your treatment decisions regarding pelvic radiation and/or chemotherapy?
At this point, for patients who lack other adverse factors, we do not change management based on positive cytology for endometrioid histology.