Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
When do you use a vaginal cuff boost with pelvic RT for stage II endometrial cancer?
Most prospective studies studying the role of external beam in endometrial cancer have treated patients with pelvic radiation (46/2 Gy or 50.4/1.8 Gy) without any brachytherapy. These studies have reported very low rates (2-3%) of in field failure in the radiation arms, so recommending external beam...
For vaginal cylinder HDR in the setting of adjuvant endometrial cancer radiation, do you routinely alter the prescription dose based on the diameter of the cylinder?
The prescription dose will remain the same regardless of the size of the cylinder that is used and should be specified to the vaginal surface (often 6 Gy x 5) or to 5 mm depth (often 7 Gy x 3). Because of the inverse square law, the dose to the non-prescription point will vary as a function of cylin...
Do you have any normal tissue constraints for endometrial cancer patients receiving EBRT and vaginal cuff brachytherapy?
We use following constraints for EBRT35 Gy to less than 35% of bowel bagRectum 40 Gy less tha 40-60% Bladder 40 Gy less than 40-60%Bone marrow ( pelvic bone) V20 less than 75% Femoral heads V35 less than 5%for brachy as adjuvant we give 5 Gy x2 to thickness of vaginaSince total dose loss limit and p...
In a female patient in her 50s with ovarian cancer who developed a whole-body rash and lip swelling 7 days after her first cycle of carboplatin, paclitaxel, and bevacizumab, how would you proceed with pretreatment for cycle 2, assuming this was a delayed reaction to carboplatin or paclitaxel?
It is very important to characterize any delayed rash after treatment with its timing, morphology, severity, and whether features of a severe cutaneous adverse reaction are present. A benign delayed rash is the most common scenario and can generally be treated with symptomatic management and enhance...
What screening tools or signs do you use to predict if a cancer patient is near end-of-life?
For most of us, long-time practicing oncologists, all we have to do to determine that one of our patients is at the end of their life is to be in the same room with them. No special computer programs or calculators are needed. Just look closely at the patient's current weight, their level of conscio...
What are your top takeaways from SGO 2026?
A pivotal theme of SGO 2026 was the dramatic rise in ADCs in every gynecologic cancer, from front-line to recurrent disease. Along with notable updates for several studies, data from others were treatment-defining. (1)The following studies were selected for further review.Ovarian Cancer: Low-grade s...
What chemotherapy would you consider to treat platinum resistant high grade serous ovarian cancer in patients with a low grade MDS from prior platinum/PARPi?
Before making a recommendation to this patient, a basic understanding of treatment related MDS/AML is needed, along with a clarification of the meaning of “low risk of progression to acute myeloid leukemia (AML)”. My main goal would be to avoid therapy with a demonstrated risk of treatment related M...
How do you approach adjuvant radiation recommendations for low-risk endometrial cancer in which the patient was unable to undergo pelvic sentinel node mapping?
Nodal assessment would not change much for me, as it’s a low-risk disease, and PORTEC data have shown the risk of nodal recurrence is low. For focal LVSI, one may consider brachy alone.
How would you manage a patient with recurrent, high-grade leiomyosarcoma involving the pelvis after salvage exenteration, but who has a focally positive anterior margin?
Ideally, plan for intraoperative radiation or surface brachytherapy at time of surgery.
For a patient with advanced serous fallopian tube carcinoma involving the uterus, cervix, and vagina who is now s/p interval debulking surgery, would you offer adjuvant vaginal brachytherapy if the upper vaginectomy margin was positive?
I would not. For advanced serous ovarian cancer, the risk of peritoneal recurrence is very high. I do not feel that vaginal brachytherapy would meaningfully affect recurrence rate or prognosis. If the patient has future isolated recurrence at the vagina, I might consider systemic therapy + radiation...