Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you typically prescribe dose to a PTV for standard IMRT plans?
Each PTV has three constraints: >/= 95% of PTV receives 100% of RX dose Max hot spot </=110% >/=99% of PTV receives >/= 93% of Rx Dose
What are best practices for oncologists during the national platinum shortage?
In breast cancer, we are prioritizing patients with curable disease in which platinum agents are a critical part of the regimen or have actually shown a clear advantage (the only example of this is shown below in bold).Use an alternative to a carboplatin-based regimen whenever possible. If no altern...
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...
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...
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.
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...
When performing GYN HDR brachytherapy with freehand needles, what strategies do you employ to immobilize the needles and prevent changes to your implant?
For over two decades, we have employed a technique using dental putty and friction collars to secure brachytherapy catheters. Initially developed to address needle migration issues in HDR prostate brachytherapy, we have successfully applied this technique to various other sites, including gynecologi...