Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you decide the right time to transition to hospice?
Talking about hospice is one of the hardest jobs we have. It's hard because we don't like doing it, because we often don't know how to do it well, and because we angst about doing it too early or too late. It's an important thing to think about. I actually think perhaps the most important factor in ...
How would you manage a patient with an incidental finding of 1 mm focus of high-grade serous carcinoma in the fallopian tube after TAHBSO was done for a benign broad ligament fibroid with negative pelvic washings?
Occult serous tubal intraepithelial carcinoma (STIC) lesions have been reported in 0.7-7.0% of BRCA mutation carriers undergoing risk-reducing salpingo-oophorectomy and invasive malignancy has been reported in 1-4% of cases.1 The reported incidence of serous tubal intraepithelial carcinoma (STIC) in...
Are there patient populations in whom you would consider using both induction chemotherapy and maintenance pembrolizumab for a patient with locally advanced cervical cancer?
Would consider for patients with multiple pelvic and high pa bulky nodes where risk of distant mets is extremely high, with the goal to treat with systemic intent, and if good response and no mets, proceed to definitive chemo-RT.
How important is the timing of weekly cisplatin in concurrent chemoradiation for definitive treatment of cervical cancer?
Weekly cisplatin in concurrent chemoradiation for cervical cancer serves as a radiosensitizer. Theoretically, it makes most sense for the chemotherapy to overlap as much as possible with the radiation. This is why typically these regimens are started on a Monday, and ideally the dose of cisplatin sh...
How do you classify extensive LVSI in endometrial cancer?
There are various definitions floating around but one with an outcome in the absence of nodal dissection is from PORTEC group showing the significance of 4 or more vessels involved.Peters et al., PMDI 34261899 Our data questions the true significance of substantial LVSI > 1 vessel as used in previou...
What is your approach to adjuvant treatment of surgically staged, deeply invasive grade 3 endometrioid endometrial cancer with no lymph node involvement?
It depends on p53 and LVSI status. If wild-type and no LVSI, I would recommend discussion with radiation oncology regarding VBT vs EBRT. If aberrant p53, I treat as uterine serous (chemotherapy with vaginal brachy or EBRT), and with extensive LVSI, I would recommend EBRT, chemotherapy, or CRT.
Do you recommend progesterone for endometrial protection in a young woman on estrogen replacement therapy for iatrogenic menopause after definitive radiation therapy for locally advanced cervical cancer?
For women with a uterus, I give a combination of estrogen and progesterone therapy, even after definitive radiation therapy. Transdermal preparations have the advantage of bypassing first-pass effect of the liver, but oral combinations are also acceptable.
In patients getting concurrent chemo-immunotherapy for locally advanced cervix cancer, would you hold immunotherapy during the 2.5-3 weeks of brachytherapy?
Pembro is continued throughout the course of treatment. Initially, every 3 weeks for 5 cycles with concurrent chemo RT plus brachy and then every 6 weeks for 15.
When do you initiate vaginal cuff brachytherapy treatment after hysterectomy for early stage endometrial cancer?
We usually start vaginal cuff treatment 5-6 weeks after hysterectomy. If adequately healed, may start at 4 weeks but not before. Rarely more than 8 weeks. For patients receiving vaginal cuff treatment plus chemotherapy, we still give cuff treatment within 6 weeks. There is no reason to delay because...
When treating endometrial cancer patients with a combination of chemotherapy and vaginal cuff brachytherapy, when do you deliver cuff brachy?
I prefer, most of the time, between the cycles of chemotherapy (1 to 3) based on logistics.