Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Would you offer adjuvant therapy for a patient with stage I high risk invasive mole after hysterectomy?
Great question! For this patient’s unique situation, although adjuvant chemotherapy is entirely appropriate, I believe it may not be necessary. The decision to offer adjuvant therapy may be cautiously delayed pending her immediate post-hysterectomy hCG levels. If there is a rapid decline in hCG, obs...
How do you approach interval cytoreductive surgery in patients with epithelial ovarian cancer requiring 6 or more cycles of neoadjuvant chemotherapy?
I think this is a really hard question. It obviously depends on why they've gotten 6 cycles of neoadjuvant chemotherapy. If they had medical problems that delayed surgery, then an interval debulking procedure makes sense. If they have progressive disease, then they are unlikely to ever be a candidat...
What is your treatment approach to a young woman with widely metastatic low grade endometrial stromal sarcoma not amenable to complete cytoreduction?
Widely metastatic low-grade ESS in a young woman is quite rare - would suggest pathology confirmation as a first step along with cytogenics/to evaluate for diagnostic fusions in this entity. Is the pattern in the abdm/pelvis? Or are there lung or other mets as well? The most effective approach/guide...
What pre-treatment findings on CT scan (if any) influence your concern for GI perforation risk with bevacizumab use in ovarian cancer patients?
This is really a two parts question. The first question would be, do you offer bevacizumab to all your ovarian cancer patients and the second question would be what patients would you not recommend bevacizumab because of concern for bowel perforation? Based on findings from GOG218 and ICON7, I only ...
How do you treat a positive margin of vulvar Paget's after radical vulvectomy?
Assuming this is a microscopically-positive margin, I recommend observation after vulvectomy. In most studies, margin status does not correlate strongly with recurrence risk. Our retrospective review of Mayo Clinic data suggested that negative margin status may be associated with a lower risk of rec...
When contouring presacral space for gynecological tumors for IMRT plans, how far inferiorly do you take your contour?
The new contouring atlas came out this month. For presacral node, caudal extent is the beginning of piriform muscle. Small Jr. et al., PMID 32905846
What treatment options would you consider for a metastatic low grade serous ovarian carcinoma that transforms to high grade?
A couple of things to consider for this case, #1 treatment-free interval #2 platinum-free interval #3 bulky disease? #4 recent tumor profiling #5 HRD status? I am assuming that she is motivated to continue treatment. If she had a good and durable response to platinum-doublet in the past then I might...
What adjuvant treatment would you recommend for Stage III vulvar cancer s/p resection with a history of prior radiation treatment for vaginal cancer?
My answer depends on the specifics of the case. Would be important to review the fields and doses. Also depends on what the perineum looks like. Are telangiectasias present with thinned epithelium consistent with significant RT dose? If the previous vaginal lesion involved distal 2/3 of the vagina, ...
Would you offer adjuvant radiation to a patient with a vaginal spindle cell sarcoma s/p modified radical hysterectomy with bilateral sapingoopherectomy with negative margins?
What type of surgery was done? A rare disease, but with close margin at a location where the wider margin is difficult, I would favor adjuvant RT with EBRT plus brachy.
What indications do you use to consider adjuvant radiation therapy for vaginal cancer s/p resection?
If it’s stage 1 disease with negative margin and nodes negative, then observe. If anything more than above, then add EBRT plus brachy.