Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
When do you expect the 2023 FIGO staging for endometrial cancer to become adopted clinically in the US?
Agree with the previous comment. Current adjuvant RT for stage I and II are based on mainly histopathological classification (PORTEC-I/II). However, the recent publication of PORTEC-4a (Horeweg et al., PMID 37487144) for stage I/II showed molecular classification predicts response for stage I/II. Mo...
How should molecular studies, in particular the presence of POLE or p53 mutations, be incorporated into the decision to treat an "intermediate risk" endometrial cancer patient with adjuvant therapy after hysterectomy?
PORTEC, ESMO, and SGO guidelines support molecular characterization of endometrial cancer based on the TCGA/ProMisE classifications. p53 is a predictive biomarker for response and prognosis while POLE is prognostic. Based on the most recent SGO clinical practice statement, these can be used to escal...
Outside of a clinical trial, do you currently incorporate the TCGA molecular classification into management decisions for patients with endometrial cancer?
I currently do not use the TCGA or ProMisE classifications to inform adjuvant therapy after surgery. Although exciting, it is premature to use this classification until we have the results of PORTEC-4a. These results will help us to better risk stratify patients and guide adjuvant treatment. That be...
How do you decide the right time to transition to hospice?
Talking about hospice is one of the hardest jobs we have. It's hard because we don't like doing it, because we often don't know how to do it well, and because we angst about doing it too early or too late. It's an important thing to think about. I actually think perhaps the most important factor in ...
Do you believe the collective data support neoadjuvant chemotherapy or primary debulking surgery for patients with advanced ovarian cancer?
At this time, primary debulking surgery should be applied whenever feasible. However, I think we still do a poor job of selecting patients for PDS versus IDS. We neglect (or do not know) how tumor biology is really affected by surgery. For instance, BRCA-mutated tumors are likely easier to accomplis...
How do you manage moist desquamation when treating vulvar cancer?
My experience is largely limited to the treatment of gynecologic malignancies, with the treatment of vulvar lesions the most common reason for development of moist desquamation. The first goal, in my opinion, is to prevent development of moist desquamation as much as possible. Skin folds that are no...
How would you manage a patient with an incidental finding of 1 mm focus of high-grade serous carcinoma in the fallopian tube after TAHBSO was done for a benign broad ligament fibroid with negative pelvic washings?
Occult serous tubal intraepithelial carcinoma (STIC) lesions have been reported in 0.7-7.0% of BRCA mutation carriers undergoing risk-reducing salpingo-oophorectomy and invasive malignancy has been reported in 1-4% of cases.1 The reported incidence of serous tubal intraepithelial carcinoma (STIC) in...
Should our selection for neoadjuvant chemotherapy in ovarian cancer patients change in light of COVID-19?
I see this as a two-pronged question where the response may vary based on the specific clinical situation, circumstances of the hospital, and status of the epidemic locally and regionally, along with available resources associated with the rapidly evolving COVID-19 pandemic. There is no question pri...
Are there patient populations in whom you would consider using both induction chemotherapy and maintenance pembrolizumab for a patient with locally advanced cervical cancer?
Would consider for patients with multiple pelvic and high pa bulky nodes where risk of distant mets is extremely high, with the goal to treat with systemic intent, and if good response and no mets, proceed to definitive chemo-RT.
How important is the timing of weekly cisplatin in concurrent chemoradiation for definitive treatment of cervical cancer?
Weekly cisplatin in concurrent chemoradiation for cervical cancer serves as a radiosensitizer. Theoretically, it makes most sense for the chemotherapy to overlap as much as possible with the radiation. This is why typically these regimens are started on a Monday, and ideally the dose of cisplatin sh...