Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
For cervical cancer intracavitary brachytherapy, do you use contrast when using CT-based planning to better visualize the ureters?
We normally do MRI based planning and the ureter can be identified and contoured on MRI. For only CT based, we do out diluted contrast in bladder for bladder contouring but do not go to the ureter. Rodríguez-López et al., PMID 33065181Koerner et al., PMID 34980569
For a patient obtaining significant benefit and no side effects from pentoxifylline/Vitamin E for radiation-induced vulvovaginal fibrosis, do you continue treatment longer than 6-7 months or discontinue?
I reassess these patients at 3 and 6 months, regardless of site (gyn or breast). If the patient is benefitting from the trental/vitamin E but still has significant fibrosis, I continue these meds for up to 2 years.
Would you cover presacral lymph-nodes in endometrial cancer patients with locally advanced disease (IIIC2 disease) who received neo-adjuvant chemotherapy prior to resection with no residual disease on pathology?
For IIIC2 endometrial cancer, we have included presacral lymph nodes routinely. There are no studies to compare with and without presacral lymph to my knowledge.
When, if ever, would you consider deep venous thrombosis prophylaxis for patients with advanced epithelial ovarian cancer undergoing neoadjuvant chemotherapy?
The Khorana scoring system is a great tool when this question comes up. I use it for all my ovarian cancer patients who have measurable disease in the neoadjuvant and adjuvant settings. I re-evaluate their score every 3 months to ensure they are still candidates for VTE ppx. Mulder et al., PMID 3060...
For patients with metachronous isolated oligometastatic cancer of gynecologic origin to the supraclavicular fossa, do you prefer standard fractionation therapy to cover the entire supraclav or SBRT to the involved nodes?
Have preferred treating the entire region with sib boost to node.
How would you approach HDR portion of cervical SCC with large area of fistula with sigmoid colon?
Consider using ultrasound every time a tandem is inserted or a Smit sleeve placed under ultrasound guidance (if not already part of routine practice) for tandem guidance, to ensure that a false tract into the fistulous bowel is not produced at the time of tandem placement. Otherwise, as noted by Dr....
When would you consider tapering glucocorticoids in a patient with ICI-associated myocarditis?
Once troponins start to decrease, I start the steroid taper and follow troponin levels. If they rise, I slow the taper. I also get serial ECGs, esp if there were arrhythmia manifestations of myocarditis. Don't forget to assess for the need for PJP prophylaxis with Bactrim or pentamidine and PPI sinc...
When treating locally advanced cervical cancer with concurrent chemoRT, do you contour the presacral LNs to the bottom of S3 or you stop your contour at S2-S3?
We contour up until we start seeing pyriform muscle like contouring guidelines for gynecological cancer. We address the differences between prostate and gyne in this letter Musunuru et al., PMID 33610294
How would you approach the adjuvant treatment of a stage IVA adenosarcoma of the ovary?
Adenosarcomas have a benign/low grade epithelial component, unlike carcinosarcoma/sarcomatoid carcinoma. The sarcomatous component is the high grade element driving prognosis, so therapy should be directed a'la sarcoma based on usual predictive factors of age, PS, organ function, etc.
How can oncologists be more collaborative with palliative care physicians?
First and foremost, for oncologists to be collaborative with palliative care physicians, a trusting relationship is a must (good communication amongst teams is key to optimal patient care). This is akin to PCP-Oncologist (or even PCP-any other specialist relationship). Before advances in science and...