Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What palliative radiation dose would you give to a patient with vulvar cancer who has an inguinal recurrence in a field previously irradiated with 45 Gy?
If only site of relapse, I would treat with definitive doses to the volume based on previous treatment and use conformal RT to avoid femoral head and neck region.
Have the presented results of GOG 249 at ASTRO 2017 changed management of early stage uterine papillary serous cancers from chemo +VC/EBRT to pelvic RT only?
UPSC tend to fail with distant mets. Therefore chemotherapy is reasonable. Per the study results Chemo + VC/EBRT is reasonable. At times chemo is not feasible/ tolerated so we use EBRT+ Vc. I have enrolled pts on this study and noted the interesting results.
In what instances would you use bolus for locally advanced vulvar cancer using IMRT?
We always start and plan with bolus for vulvar cancer for two reasons:For bringing up skin dose, and for creating flash to account for set up uncertainty and vulvar swelling.We create an IMRT plan with and without bolus in the beginning (both have flash built in).If the lesion is endophytic, then we...
What is your superior field (or CTV) border when treating para-aortic lymph nodes with extended field radiation therapy for endometrial cancer in the post-operative setting?
For prophylactic pa nodal region treatmentIi treat up to the renal vessels and dont use any bony landmark.If there is a node up to the renal vessels that is involved, then I consider extending 2 to 3 cm above the involved node including and contouring retrcrural region.See below reference for above ...
For metastatic and bulky locally recurrent carcinosarcoma, what palliative dose would you deliver to the pelvis for symptomatic control?
Based on performance status, I have done 3.7 Gy BID for 4 fractions (which can be repeated in the future if need be) or 30 Gy in 10 fractions with good palliation.
Would you treat Vaginal intraepthelial neoplasia 3 with HDR brachytherapy?
This is an option for persistent VAIN3 despite surgery and topical agent I have treated with 6 Gy x5 Important principal is where you are presecribing dose. Previous HDR studies have shown high complications because entire length was treated to fixed depth of 5 mm or so. The vaginal wall thickness v...
How would you treat HGIL in a woman with a history of early stage endometrial cancer?
It needs to be assessed by eua and biopsies. If only HGIL confirmed by bx, management needs to be conservative treatment like surgical excision and /or laser therapy.
How do you talk to patients about clinical trials?
I try to incorporate the clinical trial idea into the standard of care recommendation/discussion at the time of initial treatment decision making. After making a standard of care rx recommendation, I tell patients that my recommendation is based upon this treatment being the winner of a prior trial ...
How does a sentinel lymph node biopsy versus nodal dissection affect your treatment decision for Stage II endometrial cancer?
For stage II endometrial cancer, pelvic relapses can be at cuff, node and parametria. So if type I hysterectomy is done we favor EBRT unless all factors are favorable and stromal invasion is limited to inner 1/3 rd ( superficial )https://www.ncbi.nlm.nih.gov/pubmed/28866431
Is radiation an appropriate alternative for a patient with multiply recurrent CIN 3 being considered for hysterectomy but unable to be medically optimized for surgery?
No good data but by rationale this is reasonable Brachytherapy alone using 3D image guidance is what I would use 7 to 8 gy x 5 fractions to entire cervix