Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
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...
What adjuvant therapy would you recommend for FIGO stage IC2 (or greater) mucinous tumor of the ovary?
This is an interesting and not so infrequent case which poses many questions before answers can be given:1. Must rule out metastases from the GI tract. Has she had an EGD and colonoscopy as well as a detailed view of the pancreas and gallbladder by CT scan? Was an appendectomy performed? What is the...
What are the preferred treatment options for platinum resistant clear cell ovarian carcinoma?
We often offer these patients a clinical trial, if one is available. Unfortunately, platinum resistant ovarian cancers have low response rates to chemotherapy, and clear cell cancers are particularly resistant. Doxil, weekly paclitaxel, gemcitabine, and bevacizumab are all reasonable options.
How would you manage a localized stage IV squamous cell carcinoma of vagina involving the posterior vaginal wall and full thickness of the anterior rectal wall?
I would get staging scans including PET and MRI and plan for definitive chemo RT with a final boost, most likely with IMRT, to 66 to 70 Gy.
Would you consider initiation of bevacizumab maintenance in a patient with primary ovarian cancer after optimal debulking surgery and standard carbo/taxol if they did not receive bevacizumab beginning with the carbo/taxol?
This is a complicated question. Dr. Burger presented the final results of GOG 218 at ASCO in 2018; there was no OS benefit for the addition of avastin in the upfront setting. Despite this presentation, the FDA awarded avastin approval in this setting at around the same time; a seeming contradiction....
Is it reasonable to only treat the inguinal nodes and not the pelvic nodes in an unresectable cT1cN0 vulvar SCC at the clitoris?
If lesion is superficial one can but if thick lesion based on drainage pattern would favor both inguinal region and lower pelvic nodes
Is there a benefit to EBRT for recurrent solitary fibrous tumor/ hemangiopericytoma in patient with multiple sites of intrapelvic recurrence?
Thank you for this question. Solitary fibrous tumors, as you know, are quite rare and the mainstay of treatment is surgery if feasible. The role of adjuvant (or definitive) radiation and/or chemotherapy has been used sporadically and thus has not been well established.In this case, if there are a re...