Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
For metastatic and bulky locally recurrent carcinosarcoma, what palliative dose would you deliver to the pelvis for symptomatic control?
Based on performance status, I have done 3.7 Gy BID for 4 fractions (which can be repeated in the future if need be) or 30 Gy in 10 fractions with good palliation.
Would you treat Vaginal intraepthelial neoplasia 3 with HDR brachytherapy?
This is an option for persistent VAIN3 despite surgery and topical agent I have treated with 6 Gy x5 Important principal is where you are presecribing dose. Previous HDR studies have shown high complications because entire length was treated to fixed depth of 5 mm or so. The vaginal wall thickness v...
How would you treat HGIL in a woman with a history of early stage endometrial cancer?
It needs to be assessed by eua and biopsies. If only HGIL confirmed by bx, management needs to be conservative treatment like surgical excision and /or laser therapy.
How do you talk to patients about clinical trials?
I try to incorporate the clinical trial idea into the standard of care recommendation/discussion at the time of initial treatment decision making. After making a standard of care rx recommendation, I tell patients that my recommendation is based upon this treatment being the winner of a prior trial ...
How does a sentinel lymph node biopsy versus nodal dissection affect your treatment decision for Stage II endometrial cancer?
For stage II endometrial cancer, pelvic relapses can be at cuff, node and parametria. So if type I hysterectomy is done we favor EBRT unless all factors are favorable and stromal invasion is limited to inner 1/3 rd ( superficial )https://www.ncbi.nlm.nih.gov/pubmed/28866431
Is radiation an appropriate alternative for a patient with multiply recurrent CIN 3 being considered for hysterectomy but unable to be medically optimized for surgery?
No good data but by rationale this is reasonable Brachytherapy alone using 3D image guidance is what I would use 7 to 8 gy x 5 fractions to entire cervix
Is further workup and management required for an incidentally found small focus of neuroendocrine tumor of the endometrium?
It depends on the grade and differentiation. Primary endometrial tumors are very rare and tend to be high grade and poorly differentiated. A lower grade tumor, especially an implant on the peritoneal surface, is much more likely to be a metastasis, most likely from a GI primary. A sample obtained at...
How do you approach boosting a distal vaginal tumor (residual thickness >5mm) abutting the rectum?
I have used multichannel cylinder with or without freehand or template based on location and residual thickness. The needle would not be in rectum or abutting rectum as that would create hot spot in rectum increasing risk of complications significantly Need to make sure no hot spot in rectum and pre...
What has been your institutional or personal experience with the Venezia or other hybrid interstitial brachytherapy applicators?
I have used both Vienna and Venezia applicator. Venezia is easier to use because of the split ring (easier to insert) and has more flexibility to treat lateral parametria disease or distal vaginal extension which cant be done with Vienna. One needs to be cautious about post procedure bleeding becaus...
How do you manage urgency and frequency of bowel movements secondary to radiation proctitis?
In the acute setting we try anusol HC suppository to decrease tenesmus like symptoms