Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
In what scenario would you prefer weekly vs every 3 week carboplatin/paclitaxel for high grade serous ovarian cancer?
This is a great question without a simple answer. Let’s briefly review the pertinent data, followed by a discussion on how to use the information to consider weekly chemotherapy vs. a standard q 3-week (wk) chemotherapy regimen for primary advanced ovarian cancer.There has been increasing interest i...
In patients with recurrent advanced ovarian carcinoma and a hypersensitivity reaction to platinum, do you prefer a desensitization protocol to maximize response or switching to a non-platinum regimen?
If the patient is platinum sensitive, I would do platinum desensitization. we have very good protocols for successful desensitization.
How do you approach and manage anorexia and appetite loss in people with advanced cancer?
Anorexia/cachexia is often distressing to patients and families and it is this distress that is the target of many of the interventions for this syndrome as there are, in general, no effective therapies. Patients and families are routinely battling over the lack of eating as this causes further disc...
Would you recommend SBRT in the adjuvant settings for a solitary metastasis focus in the abdominal wall resected to R1 in a young and healthy patient with clear cell ovarian cancer?
If it is truly an R1 resection, I would observe and follow with close imaging.If she recurs, I would recommend a discussion for systemic therapy. If she has persistent disease that is amendable to SBRT, it is reasonable to treat. SBRT can prolong a chemotherapy holiday and dosing in the pelvis is us...
When performing GYN HDR brachytherapy with freehand needles, what strategies do you employ to immobilize the needles and prevent changes to your implant?
For over two decades, we have employed a technique using dental putty and friction collars to secure brachytherapy catheters. Initially developed to address needle migration issues in HDR prostate brachytherapy, we have successfully applied this technique to various other sites, including gynecologi...
In clinically node positive vulvar cancer, are you recommending bilateral inguinal LND or nodal debulking followed by adjuvant radiotherapy?
I am sure there is wide variation in practice as there is no prospective study to guide care. Our approach is definitive chemo RT with the removal of only residual persistent node. Richman et al., PMID 32981696
When is it appropriate to use adjuvant whole pelvis radiotherapy for Stage I endometrial adenocarcinoma?
The indications have been changing with the publications of GOG 99, PORTEC 1 and 2 , the Swedish and ASTEC studies, and the interpretation of data with the confounding factor of nodal dissection.At present, I would/do consider pelvic RT for Stage IB with grade 3 disease and Stage Ia with grade 3 and...
How often should you re-plan interstitial brachytherapy for gynecologic malignancies?
Ideally one should scan before each fraction to ensure needle position and account for changes in critical organ anatomy. That being said, because of logistic constraints we do QA before each fraction to check for needle displacement and if measurements are off by 2 mm or more, then we do rescanning...
What instructions do you give patients to optimize bladder filling and rectal emptying for GU and GYN simulation and treatment?
For prostate cancer treatment with external beam, IGRT is standard, so pretreatment localization of the target takes place. Because of IGRT, I don't recommend rectal filling/emptying instructions. To reduce bladder exposure, simulation and treatment with a "comfortably full bladder" is recommended.
What dose constraint do you use for the female urethra in gynecologic brachytherapy?
In our experience the tolerance is very different as the prostatic urethra and membranous urethra are very different. We have published our limited experience in Brachytherapy. When we do interstitial HDR brachy we limit 0.1 cc to 100 percent or less of what we prescribed. The 2cc concept is not app...