Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you treat severe vaginal stenosis after radiation in a patient that is already compliant with dilators?
Local estrogen helps a lot. Compliance can be a problem. I suggest that the patient will cover their applicator with estrogen and insert after she goes to bed at night and just leave it in. It will usually come out during the night but this usually beats the patient having to take time out during th...
What is your surveillance approach for outpatient monitoring of ICI myocarditis?
At Memorial Sloan Kettering, we do not use surveillance approach for standard ICI therapy. Troponins may be drawn as part of protocols/clinical trials. We do advocate for baseline troponin, especially if high sensitivity troponin is the assay being used. This helps when patients come in with symptom...
How will you treat an uterine embryonal rhabdomyosarcoma with regional node involvement resected to involved parametrial margins?
It's hard for me to say how I would treat the patient as described without a bit more information and review of the case. So, I will make a few general comments. One major question is, "What is the age of the patient?". And I assume from the question that the parametrial margins were involved. Two t...
How would you manage a patient diagnosed with squamous carcinoma involving the entire length of the vagina and extends into the vulva (introitus), who has severe vaginal stenosis?
If this is a vaginal lesion involving the vulva, it should be classified as vulva cancer and treated like so. Typically with ext beam boost to 66 to 70 Gy.
What dose would you use to treat unresectable basal cell carcinoma of the vulva?
I have treated one patient with 55 Gy in 20 Fx who is NED at 3 years post-RT. Had some acute RT toxicities similar to most vulvar cancers. Treated gross disease alone with small margin, as mentioned above.
Is there evidence to support or argue against intermittent fasting for cancer patients?
This is a complex topic with many permutations of dietary interventions similar to fasting such as calorie restriction and “fasting mimicking”, but as it pertains to pure fasting, I know of a few small studies which characterize fasting around the time of chemotherapy infusions (Raffaghello et al., ...
Given the criticism of GOG 88 and in light of various other recent data, would you deliver definitive XRT in place of inguinal lymph node dissection?
Despite GOG 88 findings, a number of retrospective studies have suggested that regional prophylactic RT is an effective method of preventing groin recurrences with minimal morbidity when appropriately delivered. (Combined across retrospective series, the incidence of groin recurrence following treat...
Which PARP inhibitor do you recommend for maintenance therapy in BRCA mutated ovarian cancer after primary chemotherapy and why?
Given the abundance of both efficacy and safety data available for Olaparib in this setting, I use Olaparib for maintenance therapy in BRCA+ ovarian cancer patients after primary chemotherapy. The 5-year PFS data from SOLO-1, confirming sustained benefit beyond the end of treatment, further speaks t...
How would you evaluate the right inguinofemoral lymph nodes in a female patient in her 30s with a 4 mm midline SCC of the vulva (depth of invasion 1.45 mm) and a PET-positive enlarged left inguinal node, for whom you plan to debulk the left inguinofemoral lymph nodes?
Sentinel evaluation of right groin nodes at the same time as left groin debulking.
How would you manage a bulky primary exophytic vulvar SqCC in a patient with uncontrolled but very long standing HIV disease?
I would first optimize HIV management and then plan for definitive RT (chemo) based on the CD4 count.