Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
When would you recommend surgical debulking of pelvic or para-aortic lymph nodes in cervical cancer prior to definitive chemoradiation therapy?
We have not favored dissection and treated with SIB and sometimes added sequential boost ( EQ@ dose 58-66 Gy) based on sizemost current literature shows excellent regional control but high distant failure in these ptsfor bowel and duodenum ( two organs which could be limiting factor) we use v55 dose...
How would you treat a woman with an isolated vaginal cuff recurrence from endometrial cancer who has received salvage resection?
I would still consider for RT as limited data suggest higher nodal relapse if only local disease addressed I would treat pelvis with EBRT followed by brachy boost but to lower total dose of 60 to 65 Gy EQ2
How would you treat indeterminate non-PET avid sub-cm common iliac nodes in a patient with locally advanced cervical cancer?
It has to be interpreted with clinical context including stage of disease and nodal staging with PET. If multiple pet positive nodes in pelvis would treat with extended field up to renal vessels and boost any suspicious node as data suggest high risk of pa failure in these pts. If no pet avid node t...
When do you consider neoadjuvant chemotherapy prior to definitive chemoradiation for cervical cancer?
Although we are occassionally referred patients for "consolidation" of loco-regional disease after favorable responses to chemotherapy for stage IVB disease, we very rarely give neoadjuvant chemotherapy for patients with stage I-IVA cancers with nodal disease confined to the pelvis and PA regions. E...
How do you apply bolus and confirm daily air gaps/setup for vulvar cancer, especially for larger, fungating lesions?
For me, I am into "wet cotton gauze" wrapped in (new) plastic wrapping daily....for it is more conformal than even the old paraffin wax molds I used to use back in the day. Clearly, it is at best a 'guess-ti-mate' as to the thickness required for each case. But it does and has worked well in my expe...
With vaginal cuff brachytherapy, do you treat to active or treatment length?
There is no consensus what length to treat. The data for 2 to 5 cm appears to have similar outcomes. We treat 3 cm length so we have 7 dwell positions but as the rectovaginal septum thins out in the mid and lower vagina, the depth of prescription of 5 mm is usually in upper 2 cm or so only. Beyond t...
When do you refer a patient with metastatic ovarian cancer for upfront debulking v. neoadjuvant chemotherapy?
In general, I would advise referring the patient to a gynecologic oncologist prior to chemotherapy as the decision regarding upfront versus interval debulking is complicated and best made assessing the patient and her imaging in person. However, if it is not possible to get the patient referred in a...
Do you recommend bevacizumab in platinum sensitive recurrences of epithelial ovarian cancer?
Bevacizumab was approved for use in combination with chemotherapy followed by continued bevacizumab maintenance in patients with platinum-sensitive recurrent ovarian cancer in December 2016. This approval was based on the findings of 2 studies, GOG-213 and the OCEANS trial. Both trials demonstrated ...
What adjuvant chemotherapy is preferred in primary ovarian mucinous adenocarcinoma of intestinal type?
Mucinous ovarian cancers are rare (3-4%) and are distinct from high grade serous ovarian cancers. Many of our trials for adjuvant chemotherapy in ovarian cancer only included small percentages of patients with mucinous histology (typically less than 5% entered in trials). While serous tumors tend to...
Should olaparib maintenance therapy be recommended in patients with BRCA-positive, advanced ovarian cancer after first line platinum-based chemotherapy?
While the results of the SOLO-1 trial are initially impressive, we need to wait for the survival data and the results of the other 2 European trials (Paola-1 and ENGOT). Definitively a field of research to keep an eye on. Today, probably premature. On a case by case basis, might be acceptable, but n...