Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
When do you transfuse cervical cancer patients undergoing chemoradiation?
Although we try to keep hemoglobin 10 gm and above for patients on chemo Rt, it is not clear whether it makes any difference to outcome. Anemia is associated with inferior treatment outcome in cervix cancer, but hemoglobin levels prior to and during treatment are strongly correlated with tumor size,...
Do you offer vaginal cuff brachy alone, vaginal cuff brachy and chemo, or WPRT for surgically staged IB grade 3 endometrial cancer?
All patients who have stage IBG3 fall into the GOG249 eligibility criteria. However, it is important to recognize that patients within this group have broadly varying risks. First of all, serous cancers (which have a greater propensity to spread intraperitoneally and may demand variant-specific appr...
Are there any situations in which you would offer brachytherapy alone instead of whole pelvis RT +/- brachytherapy for an endometrial cancer vaginal cuff recurrence?
Limited series in the past where only brachytherapy alone was done for salvage without EBRT reported high pelvic nodal relapse.One such series is Baek et al., PMID 27614661The only situation where I have done brachy alone is in patients who have had previous EBRT or have other contraindications to E...
Do you take patients off anticoagulation for tandem and ovoid or tandem and ring procedures?
We don't take them off anti coagulant for intracaviatry alone unless using a hybrid applicator
For a patient with carcinosarcoma of the uterus and an allergic reaction to paclitaxel, would you have any reservations about using docetaxel instead?
While there is no clear data for this in carcinosarcoma, Yes, I would be comfortable using Docetaxel in this scenario. I am extrapolating from ovarian cancer, where the two drugs have similar activity; The SCOTROC trial in ovarian cancer compared Carbo-Paclitaxel vs. Carbo-Docetaxel and found simila...
Would you recommend maintenance therapy with a PARP inhibitor for BRCA+ patients with advanced uterine serous cancer?
This is a data free zone, so I would hesitate to make a recommendation to use a PARP in this setting. Although, theoretically this should work if the patient has BRCA gene mutation. This would be an excellent question to answer in the form of a clinical trial similar to what Fader et al did for HER2...
Do you routinely discuss HRT with patients that have undergone surgical menopause due to treatment of cervical cancer?
Yes, I routinely discuss it with premenopausal patients and it is an important part of their care. If they will be having chemoradiation for a locally advanced cancer, I will discuss pros/cons of ovarian transposition. With adenocarcinomas, some patients do opt for oophorectomy if a radical hysterec...
How would the presence of micro-metastatic disease in multiple sentinel pelvic lymph nodes change your recommendation for adjuvant therapy in a patient with otherwise stage I endometrioid adenocarcinoma?
Currently, we treat like stage III disease with chemotherapy followed by adjuvant EBRT for decreasing LRR and control any residual nodal disease (could be 30% based on FIRES) left behind as had only SNLN done. The outcome appears to be better than macrometastases.If only ITC then no chemo for now bu...
How would you approach nodal assessment in a pregnant patient with new diagnosis of at least stage IB1 cervical SCC?
My preferred approach to nodal assessment in this patient is a robotic pelvic lymphadenectomy in the early second trimester of pregnancy after she has undergone a pelvic MRI without gadolinium.The approach to the patient with early-stage cervical cancer presenting in the first trimester of pregnancy...
How would you manage a cervical cancer patient who develops new oligomet to the spine during primary cis/RT?
The finding of metastatic disease to the spine during primary radiation therapy for cervical cancer suggests the presence of systemic, hematogenous disease at the start of treatment. PET-CT scan and/or bone scan are useful diagnostic tools to detect distant metastases and also to differentiate betwe...