Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Would you consider retrying a platinum based chemotherapy agent in a platinum resistant ovarian cancer patient?
Yes, I would consider the use of platinum agent again, especially if it has been a long time since their last platinum therapy. I could consider the use of Cisplatin in this case or Carboplatin.The GCOG consensus statement recommends the following timelines for platinum response classifications:(1) ...
Is there a role for IP chemotherapy in advanced mucinous ovarian cancers following complete cytoreductive surgery?
Whether there is a role for IP chemotherapy in advanced mucinous ovarian cancer following complete cytoreductive surgery, in my opinion, remains unknown. Because of the extreme rarity of mucinous ovarian cancer, this question may never be fully answered. For example, in the landmark study by Armstro...
Would you offer adjuvant progesterone therapy to a young woman with low grade endometrial stromal sarcoma who had elected ovarian conservation?
Hormone suppression is definitely something I would have a conversation with the patient about, with either an aromatase inhibitor, megestrol acetate, or medroxyprogesterone acetate. We know that stage is the most important prognostic factor when it comes to low grade endometrial stromal sarcomas (L...
What adjuvant therapy would you recommend for a Stage IIIC low grade serous ovarian cancer following following fertility sparing surgery?
Two observational studies guide our recommendations related to this question. In a report of 203 women with stage II-IV low-grade serous carcinoma of the ovary/peritoneum who underwent primary cytoreductive surgery, 133 underwent platinum-based chemotherapy followed by observation, and 70 underwent ...
What rectal dose constraints do you use for definitive chemoradiation for vulvar/vaginal cancer?
The anorectum can be difficult to constrain when treating vulvar cancer definitively, as the reason we are often treating with chemoRT as opposed to upfront surgery is because the tumor is located in or near the anal sphincter. For definitive treatment, I cover the primary tumor to 64Gy in 32 fracti...
What intracavitary brachytherapy regimen would you use after EBRT for a 4cm vaginal leiomyosarcoma the mid vagina with positive margins?
In general. I agree with @Dr. First Last's opinion. Vaginal sarcomas are rare, comprising less than 5% of all malignant vaginal cancer. Therefore, experience is limited and published reports sparse. It is stated that in this patient the tumor WAS 4 cm (in diameter?, largest dimension?) I assume it h...
Do you alter treatment in high grade serous ovarian cancer patients receiving neoadjuvant chemotherapy with stable disease after 3 cycles?
This is always a challenging clinical situation, as the intent of neoadjuvant chemotherapy is to reduce disease burden sufficiently to enable cytoreduction to microscopic residual disease. If disease remains stable despite administration of neoadjuvant therapy, it often denotes a biologically aggres...
Do you consider MSI testing for nonserous ovarian cancer?
I do, but with the understanding that PD1/PDL1 expression, MSI/MMR is less well documented than in high grade serous cancers. Meagher et al has a nice article in Gyn Oncol 2018 looking at molecular profiling in 333 mucinous lesions. Common mutations noted were KRAS (60%), TP53 (38%), and HER2 in up ...
Should I wear gloves during a routine physical exam on an asymptomatic patient with no risk factors for COVID-19?
As per FAQ’s posted by ASTRO: There is no reason to do so at this time. Be vigilant re: hand hygiene and wiping down any equipment that touches the patient (stethoscope, etc.). Additionally, any equipment that touches mucosa/secretions of the patient must be sterilized (rhinolaryngoscope, etc.). For...
In the setting of vulvar cancer, do you perform complete inguinal lymphadnectomy when inguinal sentinel nodes demonstrate micrometastatic (<2mm) disease?
Knowing the status of the groin nodes is critical in vulva cancer, as it has important prognostic value and is considered when tailoring adjuvant therapy. Methods chosen to assess the groin must consider morbidity vs. accuracy. I favor imaging patients pre-operatively with PET/CT if and when possibl...