Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What is the likelihood of a successful pregnancy following pelvic irradiation?
This is a very important question. The risks on future fertiltiy from radiation therapy to the abdomen/pelvis are twofold.1) Dose to the ovaries. The LD-50 to the ovaries may be as low as 2 Gy, thus the risk of ovarian dysfunction and premature menopause, is high. 2) Dose to the uterus leading to po...
After pelvic irradiation, how often do you recommend that female patients use a vaginal dilator and for how long?
The need for a vaginal dilator is dependent on the degree of stenosis, and related to the total dose, dose per fraction for HDR brachy patients, and patients underlying tendency to form scar tissue. In general we suggest evaluation by the physician every 3 months. If it appears that scar tissue con...
What is the appropriate dose for a patient with recurrent vulva VIN III?
I have never treated VIN III by itself without any evidence of invasion, although I have had patients with diffuse VIN with invasion who responded well to RT with regression of both invasive disease and VIN changes. Dose is hard to answer but all these pts get at least 50Gy for invasive disease.
Do you treat inguinal lymph nodes for patients with low lying vaginal cancers?
Yes we do. For distal vaginal cancers (not involving vulva) that have no enlarged nodes, we treat the medial inguinal nodes (e.g. nodes medial to the common femoral and saphenous veins) to 45 Gy. We do not treat the nodes lateral to the femoral vein (i.e., along the circumflex v) unless there are su...
How do you perform geriatric assessment for cancer patients?
This is a HUGE topic. I would like to suggest the following 2 resources that you may find helpful. https://www.mycarg.org/?page_id=898 and the following one helps predict residual life expectancy independent of cancer diagnosis: https://eprognosis.ucsf.edu
In the IMRT era, what role does brachytherapy play in the treatment of squamous cell carcinoma of the vulva?
We very rarely use brachytherapy to treat vulvar cancer because our experience (and that of others) has been that the rates of necrosis with brachy are very high. Any source that comes too close to the vulvar surface will cause necrosis that typically heals very slowly. Even with the best technique,...
How do you boost patients with squamous cell carcinoma of the cervix or upper vagina with invasion of the posterior bladder?
It depends on the distribution of diease and whether there is a fistula or not. If there is relatively small bladder invasion, intracavitary may provide adequate coverage; MRI-based planning is recommended. If it is a large tumor with very extensive bladder inolvement (which usually is associated wi...
Are there any situations where you would specifically not use IMRT/VMAT to treat post-operative gynecologic malignancies?
The short answer is no. Although,taking into account internal organ motion - ie., bladder and rectum - is very important to define the correct ITV and PTV. Our new atlas will be available soon and will build on our previous publication.
For what stages of primary vaginal cancer do you typically recommend concurrent chemotherapy with external beam radiation therapy?
We follow the same principal as cervical cancer and offer CRT for stage II cancer and greater, as well as, for node positive disease. We looked at NCDB database and there was increasing use of concurrent chemo for vaginal cancer with positive effect on survival
In what situations do you consider adjuvant radiation for ovarian cancer?
Our understanding of the role of RT in ovarian cancer has been evolving. In most cases, the role is at most palliative because most ovarian cancers (particularly serous cancers) are widely disseminated at presentation. However, there is a subset of patients whose disease remains locoregionally confi...