Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What is optimal timing or sequencing of therapy for patients with synchronous locally advanced triple negative breast cancer and ovarian cancer with peritoneal carcinomatosis?
Because delays in surgical healing can affect initiation of chemotherapy in ovarian cancer, I would consider neoadjuvant therapy for both the ovarian and breast cancer. Alternatively, one could do debunking surgery and then chemotherapy. I would recommend carboplatin q 3 weeks with taxol weekly x 6 ...
For metastatic small cell cervix cancer, would you consider adding immunotherapy up front (per a small cell lung cancer paradigm)?
I agree that it is "not unreasonable." It is also reasonable NOT to give it. Given that these agents can have their own toxicities, which can be significant, and the potential benefit is certainly not a "home run" (and the cost is enormous) I would not add an immunotherapy agent at present.
Would there be any contraindication to whole pelvic RT for a patient with an ax-bifem bypass & the graft crosses the lower abdomen within the RT field?
I am not aware of any contradiction and have treated patients with peripheral bypass
Would you consider radiation therapy for ovarian dysgerminoma with residual lymphadenopathy after chemotherapy?
I would not as behavior like seminoma and most of the time turns out to be a desmoplastic reaction. You can consider a PET/CT as it has high negative predictive value. But if pet positive, it could be false positive and would monitor with serial imaging rather than treat and, if needed, consider for...
Would you offer adjuvant radiation to a patient with uterine undifferentiated sarcoma s/p resection, vaginal cuff recurrence, and re-resection?
Following principles of managing sarcoma, I would favor RT with a combination of EBRT and brachy.
When would you consider radiation for a Sertoli-Leydig tumor of the ovary with a bulky mass and peritoneal metastases after surgery and BEP chemotherapy?
With peritoneal mets, I would treat only for palliation. If it was an isolated recurrence, then I would have done definitive RT.
Given the final results of GOG258, what regimen do you recommend use to treat Stage III endometrial cancer?
Full dose chemotherapy is important in stage III+ patients to prevent risk of distant failure. However, patients in GOG 258 who received chemotherapy alone had an unacceptably high risk of developing locoregional recurrence (27% 5-year incidence combining vaginal + pelvic/para-aortic). Despite conc...
Should a bowel prep be considered when performing an ovarian cancer debulking and/or bowel resection?
This remains a controversial issue, although in recent years combined mechanical and antibiotic bowel preparation has once again been incorporated into clinical practice. This transition back to bowel preparation emerged following the publication by Morris et al. (Oral antibiotic bowel preparation s...
Would you consider IP chemotherapy in a BRCA positive advanced ovarian cancer patient after upfront ovarian debulking surgery to no gross residual?
There are at least two literature sources (Naumann et al 2018 Gynecol Oncol most recently) suggesting improved survival in patients with BRCA mutations undergoing IP therapy, consistent with observations that mutated patients are more platinum sensitive. Dose intensification of platinum should there...
Is there a role for definitive radiation in a patient with vaginal melanoma who is not a surgical candidate?
Yes, for local control and preventing symptomatology. I use a combination of EBRT and brachy, with the type of brachy based on the response to EBRT. Some patients do have a complete response, although the risk of distant metastasis is very high.