Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How would you manage a patient with a subcentimeter stage I vaginal squamous cell carcinoma after a positive deep margin post local excision?
I would get MRI with vaginal gel done along with PET/CT (assuming negative) If there is no LVSI on pathology, disease is not high grade and based on MRI, I would cover vaginal wall apical residual thickness with intracavitary brachytherapy then I would treat with 7Gy x5 prescribed to volume and lim...
For patients on immune checkpoint inhibitors presenting with chest pain, dyspnea, fatigue, and troponin elevation, would you recommend early initiation of high dose steroids for empiric treatment of ICI myocarditis while pursuing workup with coronary angiogram, echocardiogram, and/or cardiac MRI, or wait until alternative etiologies have been ruled out?
This question raises an important point that the clinical presentation of ICI-associated myocarditis often overlaps with other cardiovascular disorders, including acute coronary syndrome, chronic CAD, congestive heart failure, and other nonischemic cardiomyopathies. Therefore, prompt initiation of w...
Do you routinely prophylactically anticoagulate patients undergoing systemic chemotherapy outside of the perioperative period?
No, I don’t routinely advise prophylactic anticoagulation for outpatients with gynecologic malignancies while on systemic chemotherapy who have not recently undergone surgery. However, such treatment may be considered for gynecologic cancer patients who are at high risk for venous thromboembolic dis...
Should all patients with a remote history of immunotherapy, chemotherapy and/or radiation therapy have a baseline TTE regardless of ASCVD risk?
The current ASCVD risk assessment calculators we have available do not contain cancer-specific parameters and thus are inadequate for accurate assessment of a cancer survivor's risk of developing CHF and ischemic heart disease. If patients have received mediastinal radiation therapy or high-dose ant...
In stage IIIC endometrial adenocarcinoma, does the finding of positive pelvic or para-aortic nodes after lymphadenectomy influence your whole pelvic dose?
The pelvic or pelvic plus pa dose is 45 Gy in 25 fractions for us but these suspicious nodes we would deliver concomitant boost dose of 55 Gy in 25 fractions . Iif patients have a positive pelvic node and the pa nodes were not assessed surgically we would extend field to cover pa region up to renal ...
In light of PORTEC-3 and GOG 249 data, do you use adjuvant radiation therapy alone in stage Ib serous endometrial carcinoma?
The answer is still not clear but these studies do suggest limited impact of chemotherapy in early stage adverse pathology endometrial cancer. The confounding factor is that these studies combined clear cell and UPSC together and which diluted the power of the study. Chemosensitivity of CC is not sa...
In what scenario would you prefer weekly vs every 3 week carboplatin/paclitaxel for high grade serous ovarian cancer?
This is a great question without a simple answer. Let’s briefly review the pertinent data, followed by a discussion on how to use the information to consider weekly chemotherapy vs. a standard q 3-week (wk) chemotherapy regimen for primary advanced ovarian cancer.There has been increasing interest i...
In patients with recurrent advanced ovarian carcinoma and a hypersensitivity reaction to platinum, do you prefer a desensitization protocol to maximize response or switching to a non-platinum regimen?
If the patient is platinum sensitive, I would do platinum desensitization. we have very good protocols for successful desensitization.
How do you approach and manage anorexia and appetite loss in people with advanced cancer?
Anorexia/cachexia is often distressing to patients and families and it is this distress that is the target of many of the interventions for this syndrome as there are, in general, no effective therapies. Patients and families are routinely battling over the lack of eating as this causes further disc...
Would you recommend SBRT in the adjuvant settings for a solitary metastasis focus in the abdominal wall resected to R1 in a young and healthy patient with clear cell ovarian cancer?
If it is truly an R1 resection, I would observe and follow with close imaging.If she recurs, I would recommend a discussion for systemic therapy. If she has persistent disease that is amendable to SBRT, it is reasonable to treat. SBRT can prolong a chemotherapy holiday and dosing in the pelvis is us...