Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
For an non-operative patient with IB1 cervical cancer, would you recommend RT alone or concurrent chemoRT for definitive therapy?
I usually favor RT alone as local control and the outcome is excellent unless they have adenocarcinoma, a suspicious pelvic node, or multiple high risk features (high grade with LVSI on bx).
When, if ever, would you recommend risk reducing BSO in patients with moderate penetrance breast cancer germline mutations?
RAD51C, RAD51D, and BRIP1 are all associated with significant risks of ovarian cancer and are appropriate for consideration of prophylactic oophorectomy, albeit perhaps at a slightly later age than BRCA1 and BRCA2. ATM and PALB2 may be associated with ovarian cancer risks that are similar to that of...
Would you consider modifying T&O fractionation during the COVID-19 pandemic?
We have been using 7gy x 4 instead of 5 fraction regimen in the past. A 2 fraction regimen showed lower local control in comparison to 4 fractions in the IAEA randomized trial.
Before re-challenging a patient with ICI after grade 1-2 pneumonitis, do you re-image to confirm resolution of pneumonitis?
Grade 1 pneumonitis is defined as confined to one lobe of the lung or <25% of the total lung parenchyma, while grade 2 pneumonitis is defined as involving more than one lobe of the lung or 25-50% of the lung parenchyma. Grade 1 pneumonitis is typically an incidental finding on CT in an asymptomatic ...
Would you use radiation to treat a persistent VIN III lesion that involves the urethral meatus and has recurred multiple times despite ablation and resection?
I recommend more extensive vulvar excision with a possible skin flap because: VIN is not cancer yet. Thus, radiation may not be as effective in VIN cells that are not rapidly dividing. Radiation may cause skin changes which make it more difficult to identify VIN recurrence. I am not sure what the e...
When do you recommend PD-L1 testing for patients with recurrent cervical cancer?
I think getting the testing done as soon as possible is best because very few patients will only need first line therapy. This way, there is less of a delay at the time of progression following/during first-line therapy.
What is your current practice for obtaining mutation status for a patient with newly diagnosed ovarian cancer?
My current practice is to test all newly diagnosed epithelial ovarian cancer patients (includes fallopian tube and peritoneal) with both germline multigene and somatic multigene/NGS panels. Only recently have I adopted the practice of concurrent testing at diagnosis rather than basing the decision t...
What is the longest acceptable interval between hysterectomy and vaginal cuff brachytherapy for high/intermediate risk endometrial cancer in the age of COVID-19?
We usually start no later than 9 weeks post hysterectomy. It is based on this retrospective study.
Are there circumstances where you would recommend every 6 week dosing schedule for pembrolizumab monotherapy?
FDA approval for q 6 week dosing of pembrolizumab is awaited but has yet to occur; this would represent a welcome change for our patients, as just happened with the recent approval of q 4 week dosing of atezolizumab. Without FDA approval we are not using pembrolizumab 6 week dosing at this time, and...
When do you choose dose-dense chemotherapy v. q3 week therapy in advanced epithelial ovarian cancer?
In our recent OGR, we suggested an approach to deciding which patients might be appropriate for considering the dose-dense regimen in the first line setting (Figure 2). The dose-dense JGOG regimen was shown to confer an overall survival advantage in newly-diagnosed patients with advanced disease (es...