Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you approach systemic treatment for endometrial endometrioid adenocarcinoma with neuroendocrine differentiation?
We treat these as endometrioid primary as the histologic diagnosis states, "endometrioid endometrial adenocarcinoma with neuroendocrine differentiation" instead of "primary neuroendocrine carcinoma of the uterus." Therefore, follow the literature from GOG 209 to support carboplatin/paclitaxel, espec...
What is the optimal approach for a younger female with borderline resectable cervix cancer who may need adjuvant radiation, in light of a medical history significant for ulcerative colitis?
It all depends on the colitis status on therapy including the extent and response to ongoing treatment. No induction chemo. Either radical hysterectomy with the possibility of adjuvant RT or definitive RT based on colitis status. If high risk with RT, would proceed with surgery.
For patients with endometrial recurrence of vaginal vault/pelvis, who are not candidates for brachytherapy boost, what external beam boost dose have you used following pelvic EBRT?
It’s unusual not to be able to do brachytherapy but sometimes for side wall/parametria recurrences that are not accessible, can deliver 66-70 Gy based on OAR tolerance.
After presentation of the SHAPE trial at ASCO, would you consider offering a simple hysterectomy with pelvic LN dissection for early stage cervical cancer <2cm?
Absolutely. This is the first study to actually ask this question. There has never been data showing radical hyst improves survival in early stage cervix ca. This study shows that early stage cervix ca can be treated less aggressively than previously thought. That being said, they should still see a...
How would you manage a female in her 40s with stage III cervical cancer with hydronephrosis and Crohn's disease?
I would treat with definitive chemo RT minimizing bowel exposure as much as I can with IMRT (adaptive if possible so can treat with tighter margin and IGBT) and inform the patient about the risk of complications.
What is your protocol for conscious sedation during T&O insertion?
I have used many forms of anesthesia for cervix HDR and all have some disadvantage. For the last couple of years I have moved to spinal anesthesia which has been ideal for our workflow. Patients receive a single dose of bupivicaine via CRNA/anesthesia team in our in brachy suite. The provides about ...
How would you treat an isolated port recurrence of an early stage cervical patient s/p WLE?
In limited cases we have managed this with surgery and chemoRT as definitive treatment
Would you use different EBRT field edge for an HIV positive patient with FIGO IIIC1 (2018) cervical cancer with positive bilateral external iliac nodes?
In any situation I would not favor bony landmark and use anatomical vascular landmarks. This is a review article in Seminars in Radiation Oncology summarizing nodal RT for cervical ca written with North American and European collaboration.
Do you continue Megestrol in a patient with inoperable endometrial cancer during definitive radiation therapy?
I usually stop megace as definitive RT takes care of bleeding and disease . This also reduces risk of megace induced side effects
How would you approach an inoperable, elderly, frail patient with high risk endometrial cancer?
May be less toxic, unless patient is "inoperable" because of high anesthesia risks, making endometrial brachy risky.