Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How would you manage a patient with synchronous breast and ovarian cancer, s/p neoadjuvant chemotherapy and surgery for ER+/HER2- breast cancer and found to have an ER+ ovarian cancer nodal metastases at TAH/BSO?
I usually treat my triple negative breast cancer patients (whether or not there's a deleterious mutation in the homologous recombination repair pathway, e.g. BRCA1 or BRCA2) with neoadjuvant docetaxel + carboplatin. The addition of carboplatin to taxane-based neoadjuvant chemotherapy regimens was ev...
In a patient with serous ovarian adenocarcinoma who presents with SBO due to focal involvement of the small bowel, but who has other extensive metastases and cannot get chemotherapy due to bone marrow compromise, would you recommend palliative RT in addition to venting G-tube placement?
Assuming she is expected to be platinum-sensitive and otherwise a good surgical candidate, then I would recommend an ileostomy and G-tube. I would avoid RT.
Would you offer radiation therapy for ovarian remnant syndrome?
I have treated a few times with mixed results to a dose of around 20 Gy.
What is the preferred second line agent for a woman with metastatic vulvar cancer who has progressed on carboplatin/paclitaxel?
There is not one preferred second line agent for women with metastatic vulvar cancer who have progressed on carboplatin/paclitaxel. My preference is to put those patients on clinical trial, if possible. Next generation sequencing of the tumor could guide placement into a trial (such as MATCH or TAPU...
Do you recommend concurrent cisplatin and gemcitabine with radiotherapy for unresectable vulvar cancer, as described in GOG-279?
We are still doing weekly cisplatinum with a higher dose of RT as there is concern about additional morbidity with the addition of gemzar. Richman et al., PMID 32981696
What brachytherapy dose/fractionation should be used for small cell carinoma of the cervix?
I treat a small cell carcinoma of the cervix the same as a squamous cell or adenocarcinoma as far as the RT portion of treatment. I would give 45 Gy pelvic RT (I would treat PA if involved or if there are positive pelvic nodes). I would give SIB to positive nodes to 55 Gy (2.2 Gy/fx) in the pelvis a...
Should presacral lymph nodes be included in a locally advanced endometrial cancer without cervical involvement with incomplete surgical staging (i.e. no lymph node dissection)?
The pattern of spread for lymphatics draining the uterus tend to follow a predictable pattern generally along one of two primary pathways. Lymph flows from the fundus toward the adnexa and infundibulopelvic ligaments, placing the lower para-aortic lymph node stations as a potential site for spread. ...
What staging procedures do you include for clinically apparent stage I or II ovarian cancer?
My discussion will focus on staging for epithelial ovarian cancer (EOC). Surgical staging has long been considered a pivotal step in the development of a comprehensive treatment plan for patients with apparent early-stage EOC for many reasons:1 A proportion of patients will be upstaged based on stag...
How would you treat an isolated recurrence in the pelvic muscle after prior definitive chemoradiation with brachytherapy boost for vaginal adenocarcinoma?
I would favor SBRT along with systemic treatment for the recurrent disease.
What criteria do you use when choosing an applicator system for cervical brachytherapy patients?
It is all based on institutional experience as dosimetrically there are some differences between the two applicators but would be hard to quantify any clinical outcome difference. There is increasing adoption of ring applicator possibly because of ease and convenience