Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What is your recommended radiation field in early stage vulvar cancer (T1a-b) with myelosuppression, inconclusive SLNBx, and persistent positive margins?
Would favor vulva and bilateral groin (limit to medial groin to reduce marrow exposure of femoral region).
Would you have any concerns about giving pelvic radiation in someone with a previous history of receipt of HIPEC?
I have done it a few times but important to know pelvic adhesions at the time of surgery to counsel better about the risk of SBO (pros vs. cons).
What is your approach to adjuvant vaginal cuff radiation in patients with prior definitive pelvic radiation therapy?
I do take the previous dose into account. Sometimes use a multichannel cylinder and try to control the rectum and bladder dose. Also, prescribe lower end of acceptable dose schedule like 6 Gy x 5 to surface or 4 Gy x 6 to surface.
How would you sequence treatment of a synchronous IC1 high-grade serous ovarian cancer and cT3N1 rectal cancer?
Do you personally review all imaging you order or rely judiciously on radiologist interpretation?
In my practice, I do like to review the images and the reports for all the studies I order. While I trust my radiology colleagues, I find reviewing the images myself helps both my patients and my own understanding of the disease process. For operative patients, I like to look when the study is initi...
How do you typically sequence chemotherapy and palliative radiation for metastatic endometrial and cervical cancers?
We have done it either way. Either start with RT for pain control or do it in between chemo based on the OAR dose and fractionation planned. If away for critical OAR dose and plan for single fraction, it can be done in between chemo also.
Would you order a DEXA scan for a cervical cancer patient with osteoporosis?
This is a great question and one that we should all be contemplating. I do order Dexa scans on all of my post-menopausal patients if they have not had a current baseline. Many of them have lifestyle issues that could also have decreased bone density such as low weight, tobacco and alcohol use, etc. ...
Do you routinely use prophylactic anticoagulation when treating ovarian cancer patients with neoadjuvant chemotherapy?
There are currently no standard guidelines regarding VTE prophylaxis in patients undergoing neoadjuvant chemotherapy (NACT) for ovarian cancer. ASCO recommends against routine use for patients receiving chemotherapy who are at average risk, but "suggest" prophylaxis in patients at high risk.Retrospe...
Does the risk of bowel complications change in a case where there is bowel invasion in a non functioning portion of sigmoid after diversion in a gynecologic malignancy getting CRT + brachy?
The type of bowel complications would define the risk of being symptomatic. Diversion will help with the future risk of fistula but the patient can still develop symptomatic necrosis. That being said, I would prioritize cure in this situation as persistent disease would cause more symptoms.
For a localized vaginal cuff recurrence of uterine leiomyosarcoma, what is the preferred management strategy?
I would favor surgery if feasible (upper vaginectomy is also sometimes an option) and if not, can try induction chemo or preop RT to make it resectable.