Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you optimize HDR brachytherapy for intracavitary treatment of cervical cancer?
We do image based brachytherapy (MRI based). Start with standard weighting for point A dose and there after manually adjust dwell times to get D90> or = 100% and cumultative D2cc for rectum 65 Gy or less, Bladder 80 Gy or less and sigmoid 70 gy or less With weightedd planning, majority of times dose...
How would you manage a short-interval (0-3 months) failure in the untreated para-aortic region after definitive treatment of locally advanced cervical cancer?
The current paraortic disease could perhaps be an area near the edge of the prior pelvic XRT filed. Since this is the only area of disease now and given short 3 month interval, it is reasonable to give CHEMORADIATION AND TRY TO BOOST THE GROSS DISEASE.
What is your management strategy for unresectable endometrial cancer due to gross cervical involvement with parametrial extension?
Our approach is PETCT and MRI for staging. Neoadjuvant chemo RT with external beam and brachy to EQ2 dose of 65-70 Gy folllowed by extrafascial hysterectomy and then adjuvant chemotherapybelow is link to our published datahttps://www.ncbi.nlm.nih.gov/pubmed/25218303
What dose constraint(s) would you use for a patient with a pelvic kidney transplant getting pelvic RT?
It depends on whether it is only a kidney (transplanted) or an unascended pelvic kidney with a second normal kidney. In the transplanted kidney, if the indication is adjuvant RT, then I would weigh the benefit of pelvic RT vs. long-term risk. If planned course is definitive or need to treat, I do mo...
When would you add an extra radiation dose to compensate for treatment breaks?
There is no absolute answer for this situation and additional dose is a function of the site we are treating, indication, modality of treatment, and the potential morbidity of additional treatment Like in cervical cancer, newer data suggest adding 5 Gy EQ2 with brachytherapy can mitigate effect of o...
Do you routinely offer adjuvant whole pelvis and/or extended-field radiation therapy for lymph node-positive undifferentiated uterine sarcoma with positive pelvic and para-aortic lymph nodes, respectively, after complete surgical staging?
This is such rare scenerio that I have not seen in practice with both pelvic and pa node positive. These is aggressive disease with high risk of systemic and local failure . Our approach for undifferentiated sarcoma is sytemic adjuvant chemo and discuss pros and cons of RT with no good evidence to s...
How do you approach endometrial cancer in the setting of multiple pelvic lymph nodes with ITCs and/or micromets, but no macrometastasis?
We are still learning how best to manage these patients as limited data suggests their outcome is much better and not the same as macromets. One caveat is that if only SNLN done with no dissection, than the data suggest there is risk of additional nodes which could be more than 20 percent and would ...
How do you counsel/treat a locally advanced Stage IIB cervix cancer while patient is 12 weeks pregnant?
This is individualized with discussion with patient about cancer outcomes with a delay of treatment vs. loss of pregnancy.
Are total abdominal radical hysterectomies preferred over laparoscopic hysterectomies in early cervical cancer?
Its interesting question and answer probably is not known. MIS showed higher loco regional relapse and conclusion was surgeon need to be cautious and discuss with patient pros and cons of this approach. About 15% had robotic surgery and believers feel they get wider access with robotic and they woul...
What kidney dose constraints do you use for extended field radiation for cervical cancer using VMAT or IMRT?
We follow principal of ALARA. If there is no nodal disease close to kidney, then with VMAT we use 16 Gy to 5% or less as our constraint.