Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you perform geriatric assessment for cancer patients?
This is a HUGE topic. I would like to suggest the following 2 resources that you may find helpful. https://www.mycarg.org/?page_id=898 and the following one helps predict residual life expectancy independent of cancer diagnosis: https://eprognosis.ucsf.edu
In the IMRT era, what role does brachytherapy play in the treatment of squamous cell carcinoma of the vulva?
We very rarely use brachytherapy to treat vulvar cancer because our experience (and that of others) has been that the rates of necrosis with brachy are very high. Any source that comes too close to the vulvar surface will cause necrosis that typically heals very slowly. Even with the best technique,...
How do you boost patients with squamous cell carcinoma of the cervix or upper vagina with invasion of the posterior bladder?
It depends on the distribution of diease and whether there is a fistula or not. If there is relatively small bladder invasion, intracavitary may provide adequate coverage; MRI-based planning is recommended. If it is a large tumor with very extensive bladder inolvement (which usually is associated wi...
Are there any situations where you would specifically not use IMRT/VMAT to treat post-operative gynecologic malignancies?
The short answer is no. Although,taking into account internal organ motion - ie., bladder and rectum - is very important to define the correct ITV and PTV. Our new atlas will be available soon and will build on our previous publication.
For what stages of primary vaginal cancer do you typically recommend concurrent chemotherapy with external beam radiation therapy?
We follow the same principal as cervical cancer and offer CRT for stage II cancer and greater, as well as, for node positive disease. We looked at NCDB database and there was increasing use of concurrent chemo for vaginal cancer with positive effect on survival
In what situations do you consider adjuvant radiation for ovarian cancer?
Our understanding of the role of RT in ovarian cancer has been evolving. In most cases, the role is at most palliative because most ovarian cancers (particularly serous cancers) are widely disseminated at presentation. However, there is a subset of patients whose disease remains locoregionally confi...
Do you have any advice when utilizing palliative radiation therapy in patients currently being treated with a PARP inhibitor?
This is an excellent question and certainly will become more of an issue with the recent FDA approval of olaparib for HR-defective (HRD) metastatic ovarian cancer. In addition, many other HRD metastatic cancers are being treated with this drug under compassionate use. Furthermore, the recent Phase I...
What is your approach to an optimally debulked patient with Stage Ia FIGO gr 3 serous carcinoma of the ovary?
For high grade serous early stage tumors, I use 6 cycles of carboplatin/paclitaxel. This is based on data from GOG 157 (Chan et al, Gyn Onc 2010). Single agent carbo would not be standard, but can be used in elderly or frail patients. This is a complicated situation, and treatment recommendations sh...
In what situations do you consider radiation to the pelvic and inguinal lymph nodes without treatment of the primary in vulvar cancer?
Good data in vulvar carcinoma is rare as there are not very many patients and not very many studies. Having said that, there is some data available.Among the literature is a 1994 Red Journal Article by Duesenberry et al. This is a study of 27 vulvar patients of which 13 patients had recurrences in t...
What dose is required to gross disease in the definitive treatment of vulvar cancer?
As with all gynecologic carcinomas, the optimal dose is at least to some extent dependent on the volume of disease. However, our experience suggests that a minimum of 60 Gy should always be given for gross diasease, even when concurrent chemotherapy is being given. That said, for gross disease that ...