Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How many cycles of BEP would you treat an immature teratoma of the ovary?
Assuming we are discussing a grade 2 or 3 stage I IT or stage II-IV IT, the standard of care would be to provide 4 cycles of BEP (although some have advocated for 3 cycles of BEP for low risk disease and 4 for high risk disease). (Brown et al., PMID 25341580) Following this, if tumor markers are sti...
Is there a valid hypofractionated regimen for postop cervical/endometrial cancers given COVID-19?
There are no good prospective series of hypofractionation for cervix and endometrial cancer in the curative setting.
How would you manage a recurrent uterine leiomyosarcoma, now status post secondary cytoreduction, with no gross residual disease?
NCCN guidelines recommend that isolated metastases that have been resected can be considered for treatment with postoperative systemic therapy and/or postoperative external beam RT. Observation is also an acceptable alternative for those who have no evidence of disease on postoperative imaging. This...
What is the role of a simultaneous integrated boost in vulvar cancer to the primary and nodes?
We typically do a SIB at 2 Gy per fraction to the vulvar GTV and nodes and then do a sequential boost to follow (CTV is treated at 1.8 to CTV in 25 fractions). Presumably, the nodes could be safely treated at a higher dose per fraction since there is typically not a critical structure in close proxi...
Would you give pentoxiphylline and vitamin E during HBO for vaginal necrosis?
My usual approach to treating radiation injuries in the pelvis would be to start with Vitamin E (Vit E) and pentoxifylline (PTX) for less severe radiation-related injuries, but in cases with ulceration and/or necrosis or bleeding requiring transfusion to proceed directly to hyperbaric oxygen (HBO). ...
With the recent published results of DESKTOP III, do you intend to change your practice of performing secondary cytoreductive surgery for recurrent, platinum-sensitive ovarian cancer?
Since Dr. @Dr. First Last's 2018 long awaited ASCO presentation of the results of GOG-0213, I have taken pause before considering a patient for secondary cytoreductive surgery (CRS). Over the last decade, I have also performed less primary CRS and more neoadjuvant chemotherapy. The changes in my pra...
In women of childbearing age with NMDA encephalitis and normal pelvic imaging, is there a role for oophorectomy for possible microteratoma?
Pelvic imaging of female patients with anti-NMDA-receptor encephalitis for ovarian teratoma should consist of MRI of pelvis or ultrasound of pelvis with transvaginal views. If this testing is unrevealing, the recommendation, in general, is not to proceed with oophorectomy. There have been reports of...
How would you approach a subcutaneous oligometastatic uterine carcinosarcoma?
Systemic treatment. For local, based on response to systemic, can consider local excision or hypofractionation with a schedule like skin cancer.
How do you manage internal vaginal burning during pelvic radiation?
I would start with a pelvic exam to rule out cuff dehiscence if post-op, easily treated candida infection and STI. If cuff intact, no white plaques or exudates are seen, would consider checking the plan for unintended hot spots that could lead to mucositis if that's noted. If post-operative non-endo...
What are magic mouthwash alternatives that you would recommend?
Many of our patients will make their own DIY MMW per Phil's My Pharmacist (YouTube) instructions -- uses benzocaine/Cepacol lozenges -- they say it's much more effective than the compounded one from the pharmacy. It is also more economical.If the majority of bothersome mucositis is in the oral cavit...