Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Would SBRT be recommended for a non-surgical isolated para-aortic recurrence in the setting of metastatic papillary serous ovarian cancer residual disease after systemic therapy?
There are multiple retrospective single institution and combined multi institutions studies showing RT in this setting (either SBRT or regional IMRT based on clinical scenario and nodal recurrence pattern) leads to excellent index cancer control. It prolongs chemotherapy free interval and progressio...
What recommendations are you giving when patients ask about the best 'cancer diet' to be on?
I counsel patients that there is no definitive data on "cancer fighting foods." What we do know is that nutrition is important for patients undergoing active cancer treatment and involving nutrition can be helpful - and is in fact, a component of many geriatric assessment intervention trials. Resear...
What is your approach to immunotherapy-related pancreatitis?
Depending on the severity of the ICI-associated pancreatitis, I will start patients on prednisone 0.5 mg/kg/day - 1 mg/kg/day. Once lipase levels decrease and approach normal levels, I will start tapering at generally around 10 mg weekly with a total taper time that is typically close to 6 weeks. If...
What strategies have you found to be most effective in engaging PCPs in a primary-care or shared-care model of survivorship for pediatric and AYA patients who will receive ongoing care in their communities away from their primary oncology treatment site?
This is a challenge for our center, and many other centers as well. The ideal approach would be to have adult primary care physicians associated with our center who have dedicated clinic time to care for cancer survivors, direct access to our expertise and medical records. While we haven't been succ...
How would you proceed for a patient with metastatic gastric-type adenocarcinoma, with vaginal and inguinofemoral disease only, who experiences complete response to her vaginal tumor but residual inguinal disease?
There is no ideal data to guide this. I would recommend surgical nodal excision of the residual inguinal disease, followed by pelvic and inguinal radiation (with or without platinum if the patient can tolerate further). Another approach would be with cisplatin-based chemoradiotherapy with treatment ...
Would you give adjuvant therapy after diagnosis of presumed stage IA, 5cm, ER/PR+ uterine adenosarcoma on a total hysterectomy with bilateral salpingoopheretomy without staging?
We would favor observation with no adjuvant treatment.
How do you approach a metastatic juvenile granulosa cell tumor of the ovary in a premenopausal patient following a hysterectomy and USO with the remaining ovary in situ?
In this patient who does not desire fertility (as she is s/p hysterectomy), I would recommend completion surgery with USO, omentectomy, removal of any residual peritoneal disease, assessment of lymph nodes and removal if abnormal. Would recommend platinum-based chemotherapy after surgery and reserve...
Do you offer PARP inhibitor maintenance retreatment of platinum-sensitive, relapsed, high grade serous ovarian cancer in patients who had a complete response to their most recent platinum-based chemo?
For patients with platinum-sensitive relapsed ovarian cancer with a partial or complete response to platinum-based chemotherapy, PARP inhibitors niraparib, olaparib, and rucaparib are approved by the FDA for maintenance therapy. These patients were not treated with prior PARP inhibitor therapy in th...
What is the rationale for 6 hours between EBRT and HDR fractions for BID treatment?
Based on half-life of repair of about 1.5 hours for most normal tissue (spinal cord is one of the exceptions). So 6 hours will be 90% repair with 4 half-life intervals.
In which patients with oncologic or hematologic disorders are you recommending a 3rd dose of mRNA COVID vaccine?
In the ideal world, we would tailor the need for booster shots based on whether or not a patient achieves an appropriate immunologic response and maintains that response for long periods of time. This would include both seroconversion and T-cell-mediated immunity. However, we have neither routine no...