Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you clearly communicate to parents that the main purpose of a phase I trial is to find the best dose of a new drug with the fewest side effects rather than treating the patient's cancer?
Just with any communication, check first to see what their understanding is. Then, see if they are ready to hear what you have to say. Say it and then have them repeat it. When discussing trials, this conversation occurs over more than once. At the first conversation, one may be trying to lay out op...
Which modality of RT is most appropriate for a patient with pT3N0(sn) endometrial cancer?
For T3b, I favor EBRT plus brachy as to target disease extending to parametria or vagina. For T3a with isolated adnexal involvement and favorable intrauterine factor, she would get chemotherapy for stage IIIA disease. In the past I used to offer EBRT after chemotherapy but now, if the patient is su...
How do you approach the decision of whether and when to initiate therapy in patients who remain COVID-19 positive >2 weeks after infection but are asymptomatic from the virus?
If the patient is asymptomatic or minimally symptomatic, we have elected to initiate therapy for the patient. We have treated the patient in full PPE at the end of the day with no other patients in the clinic. Efforts should be made to minimize patient contact throughout the clinic. We have the pat...
Is there a role for minimally invasive surgery in patients undergoing an interval cytoreductive surgery?
Yes! There is data supporting the feasibility. In the MISSION trial 82 women showed a complete clinical response to neoadjuvant chemotherapy (NACT). Of that, 30 were excluded for BMI >40 and/or ASA category III/IV. Of the 52 patients enrolled, 22 were undergoing laparotomy approach to interval debul...
How would you treat refractory diarrhea in a patient with low grade serous ovarian cancer treated with Trametinib?
Trametinib is known to cause significant diarrhea with 43% of patients affected with grade 1 or 2 diarrhea in phase II/III trials1. The recently released abstract for NRG-GOG 0281 reported on progression-free and overall survival, as well as toxicities related to use of Trametinib versus standard of...
How do you counsel patients with a diagnosis of EIN regarding sentinel lymph node dissection?
Though sentinel LN biopsy is feasible in this situation, I'm not sure that it is cost-effective. Emerson et al (Obstet Gynecol 2019) reported that an overall cohort of >250 patients with EIN would need to undergo sentinel LN biopsy to identify one patient with metastatic endometrial cancer. Likewise...
Any differences in the PARP inhibitors with respect to development of anemia?
Not in my experience. I have noticed that Olaparib seems to be associated with more fatigue/lethargy and low-grade nausea than niraparib, but there is no actual fall in hemoglobin.
Would you consider HIPEC in patients with advanced ovarian cancer undergoing primary cytoreductive surgery?
HIPEC is hyperthermic intraperitoneal chemotherapy and is often administered as a onetime dose after cytoreductive surgery. HIPEC has been clinically used in malignancies that can impact the peritoneal surfaces. For the following two reasons I do not administer HIPEC during surgery for patients unde...
When is it too late to start PARP manitenance after adjuvant chemotherapy in BRCA mutated ovarian cancer who had a delay in completing genetic testing?
Niraparib's prescribing information specifies that in the first-line maintenance setting, patients should start treatment no later than 12 weeks after their most recent platinum-containing regimen. In the setting of maintenance after recurrent ovarian cancer, treatment should start no later than 8 w...
How would you approach post op management of a patient s/p BSO for cystic pelvic mass with fallopian STIC lesion on final pathology?
STIC lesions are considered precursors to ovarian cancer. The role of surveillance and chemotherapy is unclear. In a comprehensive review of 78 women with isolated STIC lesions, Patrono et al found 3 patients with subsequent primary peritoneal cancer among the BRCA patients with a STIC lesion; this ...