Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Is there evidence to suggest that whole pelvic radiation is immunosuppressive and may lead to worse outcomes in the setting of chemoIO treatment for stage III endometrial cancer?
There is data showing lymphopenia with pelvic RT but no outcome data showing it will have worse outcome with IO. Rather, a GOG study for concurrent chemo RT plus IO shows improvement in outcome in comparison to chemo RT alone leading to approval of the use of pembro for stage III and IVa cervical ca...
When can abdominal surgery be safely performed for presumptive ovarian cancer in a patient with recent pulmonary emboli?
In general, the standard approach is to try to wait as long as possible after the thrombotic event, at the very least three months. This may not be possible, we then reduce that time interval to one month. Given the urgent nature of the surgical intervention, one approach is to wait one month and co...
How do you typically prescribe dose to a PTV for standard IMRT plans?
Each PTV has three constraints: >/= 95% of PTV receives 100% of RX dose Max hot spot </=110% >/=99% of PTV receives >/= 93% of Rx Dose
What are best practices for oncologists during the national platinum shortage?
In breast cancer, we are prioritizing patients with curable disease in which platinum agents are a critical part of the regimen or have actually shown a clear advantage (the only example of this is shown below in bold).Use an alternative to a carboplatin-based regimen whenever possible. If no altern...
How would you manage a patient with a subcentimeter stage I vaginal squamous cell carcinoma after a positive deep margin post local excision?
I would get MRI with vaginal gel done along with PET/CT (assuming negative) If there is no LVSI on pathology, disease is not high grade and based on MRI, I would cover vaginal wall apical residual thickness with intracavitary brachytherapy then I would treat with 7Gy x5 prescribed to volume and lim...
For patients on immune checkpoint inhibitors presenting with chest pain, dyspnea, fatigue, and troponin elevation, would you recommend early initiation of high dose steroids for empiric treatment of ICI myocarditis while pursuing workup with coronary angiogram, echocardiogram, and/or cardiac MRI, or wait until alternative etiologies have been ruled out?
This question raises an important point that the clinical presentation of ICI-associated myocarditis often overlaps with other cardiovascular disorders, including acute coronary syndrome, chronic CAD, congestive heart failure, and other nonischemic cardiomyopathies. Therefore, prompt initiation of w...
Do you routinely prophylactically anticoagulate patients undergoing systemic chemotherapy outside of the perioperative period?
No, I don’t routinely advise prophylactic anticoagulation for outpatients with gynecologic malignancies while on systemic chemotherapy who have not recently undergone surgery. However, such treatment may be considered for gynecologic cancer patients who are at high risk for venous thromboembolic dis...
Should all patients with a remote history of immunotherapy, chemotherapy and/or radiation therapy have a baseline TTE regardless of ASCVD risk?
The current ASCVD risk assessment calculators we have available do not contain cancer-specific parameters and thus are inadequate for accurate assessment of a cancer survivor's risk of developing CHF and ischemic heart disease. If patients have received mediastinal radiation therapy or high-dose ant...
In stage IIIC endometrial adenocarcinoma, does the finding of positive pelvic or para-aortic nodes after lymphadenectomy influence your whole pelvic dose?
The pelvic or pelvic plus pa dose is 45 Gy in 25 fractions for us but these suspicious nodes we would deliver concomitant boost dose of 55 Gy in 25 fractions . Iif patients have a positive pelvic node and the pa nodes were not assessed surgically we would extend field to cover pa region up to renal ...
In light of PORTEC-3 and GOG 249 data, do you use adjuvant radiation therapy alone in stage Ib serous endometrial carcinoma?
The answer is still not clear but these studies do suggest limited impact of chemotherapy in early stage adverse pathology endometrial cancer. The confounding factor is that these studies combined clear cell and UPSC together and which diluted the power of the study. Chemosensitivity of CC is not sa...