Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
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
How would you treat an advanced stage small-cell carcinoma of the ovary, hypercalcemic type? (SCCOHT)?
Small cell carcinoma of the ovary hypercalcemic type (SCCOHT) is an exceptionally rare tumor affecting patients from infancy to at least the fifth decade of life. SCCOHT tumors are characterized by mutations of the SWI/SNF member SMARCA4 that encodes BRG1. Given the rarity of SCCOHT, limited prospec...
Would re-excision of close margins (1 mm) allow a patient to avoid post-op radiation for a patient with metachronous diagnosis of a FIGO Stage IB vulvar cancer who also had a prior contralateral vulvar cancer resected 15 years ago?
Yes, would avoid RT if re-excision is done to get a wider margin.
Would you treat a uterine carcinosarcoma with omental spread with adjuvant whole abdominal radiation?
I would not offer any external beam irradiation for this patient. Even isolated omental spread in uterine carcinosarcoma represents metastatic disease. Thus, they only reasonable option is chemotherapy, usually systemic agents such as carboplatin and paclitaxel or cisplatin and ifosfamide.