Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Now that there are three FDA-approved PARP inhibitors for use in ovarian cancer (niraparib, rucaparib, olaparib), how do you decide which one to use?
One, niraparib is only approved for maintenance after treatment of platinum sensitive recurrence. Olaparib and rucaparib are approved for treating active, measurable disease. Olaparib for germline BRCA mutation carriers after 3 prior therapies, rucaparib for treating patients with germline or somati...
What is your recommended radiation field for early stage vulvar cancer with persistent positive margins (T1a-T1b)?
I agree that if the inguinal region has been adequately addressed with negative sentinel node biopsies or with an adequate inguinal node dissection that includes the femoral and superficial inguinal nodes, we would treat only the primary site. However, in these cases, we make an active attempt to li...
When would a completion inguinofemoral node dissection followed by adjuvant RT (+/- chemo) be favored over definitive RT (+/- chemo) for SLN+ vulvar cancer?
The interim analysis of the GROINSS-V II trial showed a recurrence in 12.2% (10/82) of patients treated with radiation in the setting of positive sentinel lymph node biopsy for vulvar cancer. On subset analysis the risk of nodal recurrence was 2.2% for micrometastases (< or = 2 mm) and 20% for macro...
For a young patient with stage 4 endometrial cancer with an excellent response to anthracyclines, would you continue to give anthracyclines beyond the standard dosage cap if cardiac function remains normal by echocardiogram?
A few things to consider in this case: What is the status of her stage IV disease/what response has she had to chemotherapy? How is she tolerating chemotherapy? If she has symptomatic disease and is contuning to respond to therapy, then it becomes a discussion of risk versus benefits (risk of cardio...
How soon after pelvic RT can a routine colonoscopy be completed?
I have had them get it done once acute side effects subside in 8 -12 weeks. I do inform them about avoiding rectal biopsy and informing endoscopist about it.
Given more restrictions on later line PARP inhibitor use for patients by BRCA status, would you consider repeat biopsy with somatic testing to identify candidates for second line maintenance therapy following platinum treatment for a patient who is gBRCAwt?
I would be comfortable deciding on the use of PARP maintenance in the second line based on initial somatic testing and would not feel a need to rebiopsy. Additionally, olaparib still has an indication for BRCAwt patients for maintenance post frontline regardless of biomarker status. Disclosure: No...
What palliative radiation dose would you give to a patient with vulvar cancer who has an inguinal recurrence in a field previously irradiated with 45 Gy?
If only site of relapse, I would treat with definitive doses to the volume based on previous treatment and use conformal RT to avoid femoral head and neck region.
Have the presented results of GOG 249 at ASTRO 2017 changed management of early stage uterine papillary serous cancers from chemo +VC/EBRT to pelvic RT only?
UPSC tend to fail with distant mets. Therefore chemotherapy is reasonable. Per the study results Chemo + VC/EBRT is reasonable. At times chemo is not feasible/ tolerated so we use EBRT+ Vc. I have enrolled pts on this study and noted the interesting results.
In what instances would you use bolus for locally advanced vulvar cancer using IMRT?
We always start and plan with bolus for vulvar cancer for two reasons:For bringing up skin dose, and for creating flash to account for set up uncertainty and vulvar swelling.We create an IMRT plan with and without bolus in the beginning (both have flash built in).If the lesion is endophytic, then we...
What is your superior field (or CTV) border when treating para-aortic lymph nodes with extended field radiation therapy for endometrial cancer in the post-operative setting?
For prophylactic pa nodal region treatmentIi treat up to the renal vessels and dont use any bony landmark.If there is a node up to the renal vessels that is involved, then I consider extending 2 to 3 cm above the involved node including and contouring retrcrural region.See below reference for above ...