Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
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...
What doses would you treat the primary and lymph nodes in node positive vulvar cancer patient with incidentally found focal SCC in a field of VIN3?
Not a simple question to answer with the available information but will try. Unusual to have so much nodal disease in a patient with just focal invasion in VIN3, so I would worry that there is residual invasive disease. Was there invasive disease near the margins of the excision? VIN3 that could be ...
What interventions besides lubricants do you advise to improve sexual satisfaction for patients s/p ChemoXRT for cervical cancer?
Advise a multimodal approach Additional strategies: 1) Vaginal dilator therapy. Additional visits outside of follow-ups may improve adherence 2) Vaginal moisturizers - Replens, Vitamin E oil, etc. This is outside of water-based lubricants during sexual activity 3) Topical estrogens (many of these pa...
How do you decide when to offer post-operative adjuvant treatment for a stage IC1 ovarian granulosa cell tumor?
The postoperative management of stage IC granulosa cell tumor of the ovary remains controversial. In early-stage granulosa cell tumors, the major factors that have been studied in terms of risk of relapse have included tumor size, nuclear atypia, mitotic count, and rupture. Unfortunately, there is n...
How do you manage BRCA wild-type patients with an incidental STIC found at the time of an opportunistic salpingectomy?
I would consider having the pathology reviewed to be sure they agree with STIC, and also that they do not see invasive cancer. I would make sure the patient has had comprehensive genetic testing, as we have seen STICs even with non-BRCA genes. Regardless of genotype, but depending on the age of the ...
How do you manage maintenance therapy in BRCA wild type patients who have undergone primary surgery and achieved an optimal/complete gross resection?
If they are wild type (i.e., no germline BRCA1/2 mutation) I would then test the tumor for somatic BRCA1/2. If that's negative and they have no contraindication to anti-angiogenesis therapy (eg., no wound healing complications after surgery, etc), I would put them on chemo plus BEV and continue BEV...
Do you consider tumor mutation burden as a possible biomarker for response to immune checkpoint therapy in the second line setting for cervical cancer?
According to NCCN guidelines, pembrolizumab could be used as a second line therapy for tumors that are PDL1 positive, can be categorized as MSI-high (high microsatellite instability), or are deficiency in mismatch repair (Le DT, et al. Mismatch repair deficiency predicts response of solid tumors to ...
How long would a vulvar cancer s/p definitive chemoradiotherapy, how long should the lesion be followed for regression before initiating biopsy or salvage surgery?
There is no prospective data but our practice is to perform once the acute reactions subside, usually 6-8 weeks after chemo RT.
Would you recommend EBRT/brachythrapy for any patients with stage III- IV uterine ca in light of GOG-258 data?
GOG-258 will certainly change management approach. The recurrence pattern between the two arms (higher distant mets in chemo RT arm and higher locoregional recurrence in chemo alone arm) suggests that sequencing of treatment may also matter. Our current approach is to have chemotherapy first and con...
What is your preferred sequence of chemotherapy regimens after patients with metastatic endometrial cancer develop resistance to carboplatin + paclitaxel?
This is a bit of an 'it depends' answer. If the patient has large volume disease or is highly symptomatic I will generally switch to liposomal doxorubicin. However, if the patient has more minimal disease, disease that is not imminently dangerous (nodal disease, pulmonary nodules) I will use endocri...