Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you counsel premenopausal women with BRCA1 or BRCA2 mutations on the need for bilateral oopherectomy?
I typically mirror the NCCN guidelines in this area. For those with BRCA 1 mutations, I recommend RRBSO between age 35-40 after completion of childbearing. Because those with BRCA2 mutations typically have onset of ovarian cancer later, it is reasonable to delay until age 40-45. Counseling needs to ...
What dose schedule do you prescribe to the HRCTV when using interstitial technique for treating cervical cancer with HDR brachytherapy?
I follow the American Brachytherapy Society guidelines (Brachytherapy 11 (2012) 47-52) which uses doses of 5Gyx 5 to HR-CTV after 45 GY external beam and 4.5GY x5 fx after dose of 50.4GY extrenal beam radiationOne has to be aware of increased toxicity in this BID fractionationFor Vaginal - I will al...
What is your approach for, and in which situations would you use, an external boost in the management of gynecologic cancers?
The most important and consistent indication for external boosts is in the treatment of regional disease. In nearly all cases where there is evidence or suspicions of gross nodal involvement, we treat the sites of gross disease to at least 60 Gy, while areas of microscopic disease typically receive ...
When, if ever, would you consider adjuvant pelvic radiation after chemotherapy for a completely resected localized (Stage I - II) clear cell carcinoma of the ovary?
We do consider for early stage clear cell ovarian cancer after surgery and chemotherapy with Canadian data showing a survival advantage with WAR. We, in practice, consider pelvic RT only although these patients are still very infrequently referred by Gyn oncologist http://jco.ascopubs.org/content/ea...
Which pathologic features do you use to determine VCB vs pelvic RT in Stage IA/IB endometrial patients in the era of Sentinal Lymph node Biopsy?
The decision for adjuvant treatment type for us is based on similar pathological features for node negative endometrial cancer whether node negativity is based on SNL or dissection or sampling Recent randomsied study shows 99% negative predictive value in patients in whom sentinel node is identified...
What is your approach to managing patients with medically inoperable early stage endometrial adenocarcinoma who also cannot tolerate intracavitary brachytherapy (Rotte-Y, etc) as boost?
The curative-intent treatment of medically inoperable patients can be clinically challenging. Treatment is best individualized, taking into account their comorbidities, severity of disease, and other factors. Inoperability (unsuitable for hysterectomy) is largely due to serious medical comorbiditi...
What dose/fractionation do you use when treating SCC of the vagina with vaginal cylinder brachytherapy after EBRT?
Typically, we give 5Gy x 3Fx prescribed to a depth of 5mm. However, this may be more than necessary. See this discussion: https://www.themednet.org/question/270
At your institution how are cervical cancer patients managed who are intraoperatively found by frozen section to have positive pelvic lymph nodes?
At our institution if found intraoperatively then we abondon radical hysterectomy and treat with definitive chemo RT. Idea is to avoid increased complications with combination of surgery,RT and chemo vs. only chemo RT
How should a patient be treated when they have an isolated para-aortic recurrence after upfront chemotherapy and vaginal cuff brachytherapy for intermediate risk endometrioid endometrial adenocarcinoma?
We treat with salvage RT to involved nodal region (pelvis and pa if no prior EBRT and pa only if prior EBRT to pelvis) with concurrent and sequential or sequential chemotherapy using IMRT technique and using SIB dose with 55 Gy in 25 fractions to involved node and 45 Gy in 25 fractions to prophylact...
How do you logistically give sandwich chemotherapy and whole pelvis radiation treatment in advanced endometrial cancer?
We prefer concurrent or sequential. But in the past when we have done sandwich, we have used RT after 3 cycles of chemotherapy based on most of the published data.