Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Is it necessary to include entire lymphocele in CTV while treating post operative nodal sites of pelvic malignancy?
I don’t know if necessary or not but I tend to include it if can do it safely. If large and pathological node was negative, then skip to reduce dose to OAR.
When a patient with a preexisting rheumatic disease and on immunotherapy begins to flare, how do you decide if this is an underlying rheumatic disease activity versus an immunotherapy related adverse event?
If the symptoms/signs are similar to their prior flares of their rheumatic disease, then it is likely a flare. Over 50% of patients with autoimmune diseases flare on immune checkpoint inhibitor therapy if you look at systematic literature reviews of the limited published data. If symptoms are unrela...
Would you consider definitive radiation therapy (EBRT + interstitial HDR) in lieu of pelvic exenteration for a vaginal spindle cell sarcoma?
I would not favor definitive RT unless not a surgical candidate but sometimes have been able to do EBRT plus brachy after gross total excision to avoid exenteration.
Would you consider adding adjuvant vaginal cuff brachytherapy for a FIGO 1A endometrial cancer, G1, no LVSI, based on the presence of extensive lower uterine segment involvement?
It’s not an absolute indication for adjuvant brachy with small absolute benefit.
How would you proceed when a cervical cancer undergoing brachytherapy has exceeded the rectal dose but not met the target dose?
Rectal dose and target dose have range. Preferred rectal dose for D2cc < 65 Gy but can accept up to D2cc < 75 Gy, provided you understand expected risk of complications with increased dose. Preference would be to do hybrid applicator with 3D imaging to optimize HRCTV and OAR.
How would you manage a dehiscent vaginal cuff 2 months after vaginal cuff brachytherapy?
It has to be a combination of surgery and radiation. Partial small dehiscence can sometimes be managed conservatively otherwise, most need surgical fixation.
How would you treat a recurrent ovarian malignant mixed Mullerian tumor on the pelvic side wall?
I would treat with IMRT and IGRT with total dose equivalent to 66 Gy based on OAR dosimetry to buy time without chemo and improve PFS.
What features help distinguish thyroid myopathy from immune checkpoint inhibitor-associated myopathy?
Immune checkpoint inhibitors (ICIs) can cause myositis (ICI-myositis). Since ICIs can also induce hypothyroidism, myopathy secondary from hypothyroidism can also be associated with ICI therapy. Different from thyroid myopathy, patients with ICI-myositis barely have myoedema or muscle pseudohypertrop...
For a cervical cancer patient who had involved para-aortic lymph nodes, how much higher do you extend the superior edge of your field if there are nodes close to the renal vessels (i.e. usual superior extend of field)?
In this dataset from us, next station was retrocrural nodes with involvement more than 25% and for that reason, we extend CTV for 2-3 cm above renal vessel to include retrocrural nodal region and space.Kabolizadeh et al., PMID 23849691
Is adjuvant RT recommended for a Bartholin's gland SCC s/p piecemeal resection with deep invasion and negative ipsilateral LN dissection?
I agree with Dr. @Dr. First Last that it is a function of margin status. However, with deep invasion and piecemeal resection, I think that margin status would be difficult to determine. A small lesion may be able to be reresected but many times, because of the location in the bartholins gland, the t...