Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
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
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...