Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Do you routinely offer adjuvant whole pelvis and/or extended-field radiation therapy for lymph node-positive undifferentiated uterine sarcoma with positive pelvic and para-aortic lymph nodes, respectively, after complete surgical staging?
This is such rare scenerio that I have not seen in practice with both pelvic and pa node positive. These is aggressive disease with high risk of systemic and local failure . Our approach for undifferentiated sarcoma is sytemic adjuvant chemo and discuss pros and cons of RT with no good evidence to s...
How do you counsel/treat a locally advanced Stage IIB cervix cancer while patient is 12 weeks pregnant?
This is individualized with discussion with patient about cancer outcomes with a delay of treatment vs. loss of pregnancy.
Are total abdominal radical hysterectomies preferred over laparoscopic hysterectomies in early cervical cancer?
Its interesting question and answer probably is not known. MIS showed higher loco regional relapse and conclusion was surgeon need to be cautious and discuss with patient pros and cons of this approach. About 15% had robotic surgery and believers feel they get wider access with robotic and they woul...
What kidney dose constraints do you use for extended field radiation for cervical cancer using VMAT or IMRT?
We follow principal of ALARA. If there is no nodal disease close to kidney, then with VMAT we use 16 Gy to 5% or less as our constraint.
How would you manage a patient with a h/o HSIL & VAIN3 and recent colposcopic vaginal biopsies "highly concerning for exophytic pattern squamous cell carcinoma" refusing vaginectomy?
I have treated with image guided brachy. I use MRI for planning and a multichannel cylinder. Our dose is 6Gy x 5 or 7Gy x 5 prescribed to thickness of vagina seen on MRI, (varies across length) respecting doses to critical organs.
How do you manage vaginal dehiscence discovered during vaginal brachytherapy?
You need to withdraw the applicator and keep patient supine. The patient will require admission and emergent surgery to fix the defect, otherwise bowel loops may prolapse through the defect.
Does size influence your decision making for women with low or low-intermediate risk endometrial cancer after hysterectomy?
In otherwise low risk disease where I would favor observation, I do discuss pros and cons of adjuvant cuff brachytherapy if size greater than 2.5 cm or so.
Is it safe and/or necessary to combine osimertinib and carboplatin/paclixel for a patient with stage IV EGFR mutated NSCLC and advanced ovarian carcinoma?
This is a tough situation and a lot depends on the status and urgency of the ovarian cancer and whether surgery is planned for it. I would not combine the chemotherapy and osimertinib simultaneously for sure. There are several studies that show the combination of chemo and TKI is not as good as TKI ...
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...