Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
If a premenopausal woman underwent a hysterectomy with unilateral SO with final pathology demonstrating an intact mucinous borderline tumor with negative washings, would you take her back for surgical staging?
No, I would not take her back. NCCN guidelines affirm that a patient with incompletely staged, or incompletely resected borderline tumor may be observed if CT chest, abdomen, and pelvis reveals no residual tumor. Surveillance should be sufficient.
Why do we use dexamethasone for CNS edema and prednisone for pneumonitis?
Dexamethasone has better CNS penetration compared to prednisone and thus its established use for managing vasogenic edema. However, it has the most suppressive effect on ACTH, causes relatively more steroid myopathy and has less mineralocorticoid effect compared to prednisone hence, the general use ...
How do you manage real-time release of pathology and radiology results to oncology patients following enaction of the CURES act?
Even prior to the Cures Act, I worked in a place where lab and imaging results were immediately available to patients through their smartphone app. A few memorable encounters: Patient 1 - told me his favorable PSA result when I walked in the room and basically told me the plan going forward, (which ...
What is your preferred approach to adjuvant treatment for stage IC grade 1 endometrioid ovarian adenocarcinoma?
Carbo/taxol x 6 Genetics
Are there best practices or data regarding the use of open notes among oncology patients?
The 21st Century Cures Act regulation (effective April 2021) required that clinical notes such as consult and office notes be shared with patients, e.g. “open notes.” In general, surveys of patients with cancer and their clinicians suggest that open notes are viewed favorably (Salmi et al., PMID 330...
Do you routinely use mannitol to prevent cisplatin-induced nephrotoxicity?
Having treated thousands of patients over the past several decades, we NEVER use mannitol nor do we find any logic for its administration in patients getting appropriate pre-chemo and post cisplatin saline hydration.
Would you offer RT alone to an elderly woman with squamous cell carcinoma in-situ of the vulva, distal vagina, and periurethral area?
I have had such a patient; multiply recurrent over a relatively large field such as this case. I gave her RT alone (45-50.4Gy) to central structures with large margin (no nodal treatment) and she was recurrence free for 5 years (last time I saw her).
Would you consider HIPEC in a known BRCA+ IIIC ovarian cancer patient undergoing interval debulking surgery if the patient is known to desire PARPi maintenance following completion of chemotherapy?
Yes. There is currently no known stratification for BRCA patients undergoing HIPEC. OVHIPEC1 demonstrated an 11 mo. OS benefit in stage III patients undergoing interval CRS with HIPEC. In this study, patients did not undergo maintenance PARPi. BRCA patients have previously reported to have better ou...
How do you manage patients with chemotherapy-induced paronychia?
I manage patients with chemotherapy-induced paronychia with a few tricks: First, ensure that there is no infection (active drainage, especially purulent) is more indicative of infection, as well as appropriate hygiene. Topical steroids and soothing soaks (such as Domeboro or diluted distilled white ...
Would you consider a PARP inhibitor in the treatment of a PARP inhibitor naïve platinum resistant recurrent ovarian cancer with LOH/HRD?
These are challenging scenarios and with increasing PARP use in the upfront setting, especially (likely) in the LOH/HRD patients I suspect this clinical scenario may become less frequent in the future. For now, it's appealing to suggest that LOH/HRD scores as a biomarker can be examined in a vacuum ...