Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Given the final results of GOG258, what regimen do you recommend use to treat Stage III endometrial cancer?
Full dose chemotherapy is important in stage III+ patients to prevent risk of distant failure. However, patients in GOG 258 who received chemotherapy alone had an unacceptably high risk of developing locoregional recurrence (27% 5-year incidence combining vaginal + pelvic/para-aortic). Despite conc...
Should a bowel prep be considered when performing an ovarian cancer debulking and/or bowel resection?
This remains a controversial issue, although in recent years combined mechanical and antibiotic bowel preparation has once again been incorporated into clinical practice. This transition back to bowel preparation emerged following the publication by Morris et al. (Oral antibiotic bowel preparation s...
Would you consider IP chemotherapy in a BRCA positive advanced ovarian cancer patient after upfront ovarian debulking surgery to no gross residual?
There are at least two literature sources (Naumann et al 2018 Gynecol Oncol most recently) suggesting improved survival in patients with BRCA mutations undergoing IP therapy, consistent with observations that mutated patients are more platinum sensitive. Dose intensification of platinum should there...
Is there a role for definitive radiation in a patient with vaginal melanoma who is not a surgical candidate?
Yes, for local control and preventing symptomatology. I use a combination of EBRT and brachy, with the type of brachy based on the response to EBRT. Some patients do have a complete response, although the risk of distant metastasis is very high.
Would you consider retrying a platinum based chemotherapy agent in a platinum resistant ovarian cancer patient?
Yes, I would consider the use of platinum agent again, especially if it has been a long time since their last platinum therapy. I could consider the use of Cisplatin in this case or Carboplatin.The GCOG consensus statement recommends the following timelines for platinum response classifications:(1) ...
Is there a role for IP chemotherapy in advanced mucinous ovarian cancers following complete cytoreductive surgery?
Whether there is a role for IP chemotherapy in advanced mucinous ovarian cancer following complete cytoreductive surgery, in my opinion, remains unknown. Because of the extreme rarity of mucinous ovarian cancer, this question may never be fully answered. For example, in the landmark study by Armstro...
Would you offer adjuvant progesterone therapy to a young woman with low grade endometrial stromal sarcoma who had elected ovarian conservation?
Hormone suppression is definitely something I would have a conversation with the patient about, with either an aromatase inhibitor, megestrol acetate, or medroxyprogesterone acetate. We know that stage is the most important prognostic factor when it comes to low grade endometrial stromal sarcomas (L...
What adjuvant therapy would you recommend for a Stage IIIC low grade serous ovarian cancer following following fertility sparing surgery?
Two observational studies guide our recommendations related to this question. In a report of 203 women with stage II-IV low-grade serous carcinoma of the ovary/peritoneum who underwent primary cytoreductive surgery, 133 underwent platinum-based chemotherapy followed by observation, and 70 underwent ...
What rectal dose constraints do you use for definitive chemoradiation for vulvar/vaginal cancer?
The anorectum can be difficult to constrain when treating vulvar cancer definitively, as the reason we are often treating with chemoRT as opposed to upfront surgery is because the tumor is located in or near the anal sphincter. For definitive treatment, I cover the primary tumor to 64Gy in 32 fracti...
What intracavitary brachytherapy regimen would you use after EBRT for a 4cm vaginal leiomyosarcoma the mid vagina with positive margins?
In general. I agree with @Dr. First Last's opinion. Vaginal sarcomas are rare, comprising less than 5% of all malignant vaginal cancer. Therefore, experience is limited and published reports sparse. It is stated that in this patient the tumor WAS 4 cm (in diameter?, largest dimension?) I assume it h...