Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Is there a role for leucovorin in a patient who is 3 days post her most recent treatment dose of methotrexate for GTN, who is experiencing grade 3 mucositis?
I would give it, but it has not been shown to be effective. I just feel like I should do something.
What adjuvant treatment would you recommend for a patient with FIGO 2023 IIIB2 endometrioid endometrial adenocarcinoma (Grade 3, p53mut, MMR proficient), metastatic to the uterine serosa, bilateral ovaries, and anterior peritoneal reflection?
Chemotherapy followed by pelvic RT
What is your approach to cancer patients who inquire about alternative or complementary treatments?
It depends a little bit on what specifically they want to use, and if they are truly investigating alternative medicine or complementary medicine. For people seeking full alternative medicine without any conventional treatment, I tell them that a research study showed that people who pursued the alt...
For vaginal cuff recurrence of an endometrial cancer, when do you utilize a multichannel cylinder versus single channel cylinder if a patient has <5 mm residual disease after EBRT?
If disease is confined to one wall, favor MC applicator as I treat vaginal wall thickness for side involved while surface on other side. MC allows that flexibility.Here is the link to our publicationGebhardt et al., PMID 29929925
For an elderly woman with a platinum-resistant recurrence of a high-grade serous ovarian cancer who has been rendered NED surgically, is observation a reasonable approach?
Based on her age, performance status, and goals of care, it is certainly reasonable to discuss all options with patients. With her being platinum resistant, I would counsel on prognosis and the need to consider quality of life. With the need for balance between QoL and OS, waiting until there is a m...
How do you manage patients with germline BRCA mutations who have STIC lesions found at the time of risk-reducing BSO?
How do you manage patients with germline BRCA mutations who have STIC lesions found at the time of risk-reducing BSO?Most experts agree these are worrisome lesions, likely precursors to high-grade serous carcinoma (HGSC). It is also biologically plausible that the presence of serous tubal intraepith...
How do you factor a decreasing but persistently elevated CA-125 into your decision regarding whether to proceed with interval cytoreductive surgery for PAX8+ high-grade serous cancer s/p neoadjuvant chemotherapy with minimal disease on imaging?
I don’t let the CA-125 influence my decision to perform interval debulking. If the patient has had a good radiologic response to neoadjuvant chemotherapy and has minimal disease on imaging, I proceed with interval debulking with the goal of an R0 resection regardless of the CA-125.
How would you approach a pre-viable pregnant patient in the second trimester with metastatic ovarian cancer who wants to keep the pregnancy?
I would recommend neoadjuvant chemotherapy and co-manage with maternal-fetal medicine to try to optimize the outcome for both mom and baby. Typically, we will start chemotherapy (platinum-based) after organogenesis is complete and continue q21 days until about 3-4 weeks before planned delivery. Once...
How would you evaluate the role for adjuvant radiation in a very young female (20s) with a localized vulvar SCC, HPV independent, status post hemivulvectomy?
Either re-excision or observation provided no dVin at margin and at least a 3 mm negative margin for invasive disease.
Would you offer systemic chemotherapy to a patient with at least 2023 FIGO stage IC high grade serous (p53-mut) endometrial cancer with extensive LVI for whom nodal assessment was not done?
This question was addressed in a large NCDB study in 2020 by Nasioudis et al (Nasioudis et al., PMID 32675056) who looked at USC confined to the endometrium, which found that 5-year OS was 91% for chemo alone, 91% for chemoRT, 85% for those who received radiation alone, and 82% who were observed. Ad...