Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
In what circumstances would you offer adjuvant radiation after resection of vulvar mucosal melanoma?
If immunotherapy is indicated, I would start that right away. I would treat for positive margins or melanoma in situ at the margins using 30/5-6 fx twice a week. Would treat the tumor bed with a 10-15mm margin. I wouldn't treat the groins. Would also recommend a thorough GYN exam in the OR if not d...
How would you treat a patient who has an inguinal p16+ SCC lymph node of unknown origin?
We have published a 60% 5yr OS for SCCa of unknown primary. The two most likely primary sites are anal cancer and vulvar cancer. Please see my previous posts for anal cancer doses. I would treat this patient to the ipislateral inguinal external and common iliac nodes. Once could consider treatment o...
What toxicities related to mirvetuximab have you seen in your patients and how have you managed them?
The most common side effects we experience are ocular and have been relatively well controlled with ocular mitigation strategies and expectation discussions prior to starting. The most severe adverse event we have experienced is pneumonitis which needs to be recognized with prompt action. Unfortuna...
How do you approach adjuvant therapy for patients with advanced ovarian cancer who undergo interval debulking surgery following six cycles of neoadjuvant chemotherapy?
If viable tumor at the time of surgery and patient has acceptable performance status then I would treat 2-3 more cycles of chemo followed by maintenance therapy. However, if no viable tumor at the time of surgery then I would forego IV chemotherapy and start maintenance postoperatively depending on ...
How would you treat a recurrent, metastatic invasive Paget's disease of the vulva?
Just to clarify, this is a recurrence within the radiated groin, and that recurrent groin node has been resected so there is no gross disease currently? Any treatment for metastatic, recurrent invasive vulvar Paget’s disease will be non-curative/palliative, so at this post, if there is no gross dis...
Would you treat the whole bladder with a cervical cancer that is invading the bladder?
The short answer is no. The posterior wall of the bladder is generally what will be involved and will be in the PTV anyway. This is how I would approach planning: I would fuse the MR T2 sequence with my planning CT, and use the cystoscopy report as well to ensure that the involved portion of the bl...
How long of a delay are you willing to accept for vaginal cuff brachytherapy either as primary therapy or as boost?
The absolute benefit of vaginal cuff HDR boost is small and 6 months delay would negate any such benefit.
How would you approach an adolescent patient with stage IIIC serous borderline tumor, s/p fertility sparing surgical staging with unilateral salpingo-oophorectromy, who presents with an enlarging contralateral ovarian mass and additional pelvic disease on imaging?
I would attempt cystectomy and debulking of pelvic disease. If ovarian salvage is not possible, then I would prioritize saving the uterus. If final pathology continued to show borderline tumor, then I would observe. If low-grade serous or high grade serous on final pathology, then I would treat with...
What normal tissue dose constraints do you use when delivering up to 3 cycles of the palliative quad shot regimen for gynecologic pelvic malignancies?
I don’t follow fixed dose constraints but adjust based on the volume of disease and the volume to treat.
How do you manage insomnia in cancer patients that is refractory to traditional sleep aides?
Insomnia and other sleep disturbances are very common in individuals diagnosed with cancer, and it is often helpful for patients to hear this. A good history of other contributors to sleep disturbance can be helpful as well. Often, depression, anxiety, and pain, as well as other stimulant medication...