Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
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 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...
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?
We generally extrapolate treatment of vulvar carcinoma from data on cervical cancer as both are lower genital tract HPV-associated cancers. Vulvar cancer is rare enough that randomized trials and even single arm phase II trials have not typically been done. Thus, I usually add bevacizumab to initial...
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