Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What is your response to the question, "Is this terminal?"
Thanks for this question, it's really important. This question comes up in two distinct scenarios: when a person is first diagnosed and when a person is nearing the end of her life. Let's talk about them in sequence. 1). At diagnosis: When a person is first diagnosed, this question is part of "getti...
What palliative regimen do you use for intra-pelvic recurrence of cervical cancer after definitive chemoRT with T&O brachytherapy?
Based on performance status, expected survival, the time elapsed from previous RT, and volume to treat, have used quad shot to 24-30 in 12 to 15 fraction or salvage HDR interstitial to EQ2 dose of 40 Gy or so.
Is your approach to managing immune related adverse events altered at all in light of COVID-19?
First of all, I wish to thank @Dr. First Last from Johns Hopkins/Sibley for his advice addressing this critical topic.We are all witnessing a rapidly evolving crisis that none of us have been prepared for and it is the right thing to quickly consider as best as we can how the COVID-19 pandemic shoul...
How do you sequence chemotherapy with radiotherapy for advanced endometrial cancer?
Unfortunately, we don’t even know for sure if we need RT for stage III disease.GOG 258 showed early concurrent chemo RT is no better than chemotherapy alone (delaying chemo increased distant mets, which probably negated locoregional control benefit of RT). For this reason, chemotherapy has become st...
How do you choose 1st line therapy for recurrent cervical cancer?
I use the Moore criteria and if the score is greater than or equal to 2, I will evaluate the patient for contraindications to bevacizumab and if none, I will counsel her to receive bevacizumab plus chemotherapy. The chemotherapy backbone is cisplatin-paclitaxel if the patient did not receive cisplat...
Would you consider chemoradiation + chemotherapy as in PORTEC-3 regimen for p53 mutated stage IA endometrial cancer, though this trial did not include those with stage IA disease?
There are not sufficient data to recommend this regimen in patients with stage IA endometrioid endometrial cancer. In subset analysis of patients with grade 3 endometrioid cancer with + LVSI, there was no difference in recurrence free or overall survival (OS) with the addition of chemotherapy. For p...
In a fit/young patient, how do you manage endometrial cancer with inguinal node involvement that has had favorable response after upfront systemic therapy?
If operable after chemo then surgery followed by adjuvant RT.
How would you approach a young patient with a locally advanced endometrial cancer with cervical involvement and a solitary bone metastasis?
I would need to know what is meant by locally advanced endometrial cancer. Locally advanced cervical cancer usually means not operable (except IB2) so is this a T3N?M1 pt with a bone met? That is IVb. I agree with bone biopsy but endo does go to bone so I would not be surprised if this was positive....
For patients with metachronous isolated oligometastatic cancer of gynecologic origin to the supraclavicular fossa, do you prefer standard fractionation therapy to cover the entire supraclav or SBRT to the involved nodes?
Have preferred treating the entire region with sib boost to node.
As a primary care provider, how do I reconcile the different types of immunosuppression? I realize that solid organ transplant immunosuppression is much more intense and riskier compared to medications like Humira or Dupixent, or an undetectable viral load in HIV. How do these differences affect cervical cancer screening?
Dr. @Dr. First Last, I like this question a lot. We rheumatologists can tend to forget how complicated this topic can be.I. Hydroxychloroquine (Plaquenil), the #1 drug to treat SLE, is often mistaken as an immunosuppressant, but it is not. It is an immunomodulatory therapy without true immunosuppres...