Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What personnel does your department require to safely deliver vaginal cylinder brachytherapy, other than treating radiation oncologist and physicist?
We have dedicated nursing staff and specialized brachytherapy radiation therapists who are all integral for all of our procedures, including vaginal cylinder brachytherapy.
How do you approach adjuvant treatment of non-uterine leiomyosarcoma?
I do not offer adjuvant chemotherapy to persons with leiomyosarcoma. One can make a case that the large negative randomized study EORTC 62931 published in 2012 supplants the 2008 meta-analysis of smaller studies that showed survival benefit from adjuvant chemo. Woll et al., PMID 22954508Neither is t...
Would you offer adjuvant radiotherapy to a recurrent HPV-independent vulvar cancer located close to the anus, which was resected with very close (0.8 mm) margins?
I would favor RT and include the inguinal region as with local recurrence, there is about a 15% risk of nodal involvement.
What is the optimal treatment for adenocarcinoma of the vulva?
I don’t know what is optimal but usually, they are associated with Paget's disease or Bartholin gland tumor and we follow the surgical principle same as SCC followed by adjuvant RT as indicated based on margin or nodal status.
What is your treatment approach for a pediatric patient with uterine embryonal rhabdomyosarcoma found after removal of a prolapsing uterine mass, with no evidence of distant metastasis on imaging?
Based on the location of the uterus, this would be a favorable site. In the scenario presented, the tumor is noted to be removed, but the margin status is not noted, which could greatly affect the approach. Also, the exact uterine location (such as cervix vs body of the uterus) may make a difference...
How many cycles of BEP would you treat an immature teratoma of the ovary?
Assuming we are discussing a grade 2 or 3 stage I IT or stage II-IV IT, the standard of care would be to provide 4 cycles of BEP (although some have advocated for 3 cycles of BEP for low risk disease and 4 for high risk disease). (Brown et al., PMID 25341580) Following this, if tumor markers are sti...
Is there a valid hypofractionated regimen for postop cervical/endometrial cancers given COVID-19?
There are no good prospective series of hypofractionation for cervix and endometrial cancer in the curative setting.
How would you manage a recurrent uterine leiomyosarcoma, now status post secondary cytoreduction, with no gross residual disease?
NCCN guidelines recommend that isolated metastases that have been resected can be considered for treatment with postoperative systemic therapy and/or postoperative external beam RT. Observation is also an acceptable alternative for those who have no evidence of disease on postoperative imaging. This...
What is the role of a simultaneous integrated boost in vulvar cancer to the primary and nodes?
We typically do a SIB at 2 Gy per fraction to the vulvar GTV and nodes and then do a sequential boost to follow (CTV is treated at 1.8 to CTV in 25 fractions). Presumably, the nodes could be safely treated at a higher dose per fraction since there is typically not a critical structure in close proxi...
Would you give pentoxiphylline and vitamin E during HBO for vaginal necrosis?
My usual approach to treating radiation injuries in the pelvis would be to start with Vitamin E (Vit E) and pentoxifylline (PTX) for less severe radiation-related injuries, but in cases with ulceration and/or necrosis or bleeding requiring transfusion to proceed directly to hyperbaric oxygen (HBO). ...