Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How long would a vulvar cancer s/p definitive chemoradiotherapy, how long should the lesion be followed for regression before initiating biopsy or salvage surgery?
There is no prospective data but our practice is to perform once the acute reactions subside, usually 6-8 weeks after chemo RT.
Would you recommend EBRT/brachythrapy for any patients with stage III- IV uterine ca in light of GOG-258 data?
GOG-258 will certainly change management approach. The recurrence pattern between the two arms (higher distant mets in chemo RT arm and higher locoregional recurrence in chemo alone arm) suggests that sequencing of treatment may also matter. Our current approach is to have chemotherapy first and con...
What is your preferred sequence of chemotherapy regimens after patients with metastatic endometrial cancer develop resistance to carboplatin + paclitaxel?
This is a bit of an 'it depends' answer. If the patient has large volume disease or is highly symptomatic I will generally switch to liposomal doxorubicin. However, if the patient has more minimal disease, disease that is not imminently dangerous (nodal disease, pulmonary nodules) I will use endocri...
Would you offer radiotherapy or chemotherapy a patient with cervical cancer s/p radical hysterectomy and now a delayed metastasis to the ovary that was completely resected without tumor spill?
I agree with everything said so far. Extremely rare situation. I suppose I would add that the devil is sometimes in the details. Age? How far out from hysterectomy? was the ovary large? Difficult dissection that might suggest disease left in adjacent tissues? Also important to check with the patholo...
What is optimal timing or sequencing of therapy for patients with synchronous locally advanced triple negative breast cancer and ovarian cancer with peritoneal carcinomatosis?
Because delays in surgical healing can affect initiation of chemotherapy in ovarian cancer, I would consider neoadjuvant therapy for both the ovarian and breast cancer. Alternatively, one could do debunking surgery and then chemotherapy. I would recommend carboplatin q 3 weeks with taxol weekly x 6 ...
For metastatic small cell cervix cancer, would you consider adding immunotherapy up front (per a small cell lung cancer paradigm)?
I agree that it is "not unreasonable." It is also reasonable NOT to give it. Given that these agents can have their own toxicities, which can be significant, and the potential benefit is certainly not a "home run" (and the cost is enormous) I would not add an immunotherapy agent at present.
Would there be any contraindication to whole pelvic RT for a patient with an ax-bifem bypass & the graft crosses the lower abdomen within the RT field?
I am not aware of any contradiction and have treated patients with peripheral bypass
Would you consider radiation therapy for ovarian dysgerminoma with residual lymphadenopathy after chemotherapy?
I would not as behavior like seminoma and most of the time turns out to be a desmoplastic reaction. You can consider a PET/CT as it has high negative predictive value. But if pet positive, it could be false positive and would monitor with serial imaging rather than treat and, if needed, consider for...
Would you offer adjuvant radiation to a patient with uterine undifferentiated sarcoma s/p resection, vaginal cuff recurrence, and re-resection?
Following principles of managing sarcoma, I would favor RT with a combination of EBRT and brachy.
When would you consider radiation for a Sertoli-Leydig tumor of the ovary with a bulky mass and peritoneal metastases after surgery and BEP chemotherapy?
With peritoneal mets, I would treat only for palliation. If it was an isolated recurrence, then I would have done definitive RT.