Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Is there a role for reassessing somatic mutation status at relapse in patients with epithelial ovarian cancer?
No – I don’t think there is any role for reassessment at this point. If commercialization of testing for reversion mutations becomes available – and it will or a functional test of HR status – then yes – I would reassess but I don’t see a reason at this point.
How would you manage a patient with recurrent stage IIIC granulosa tumor following secondary, R0 cytoreduction?
There is not a lot of data to go on in this situation. R0 resection is probably one of the best predictors for survival. Karalok et al., PMID 27174627 reported on a series of 18 patients undergoing resection of recurrent disease. Complete resection resulted in PFS and OS > 200 months.In general, the...
What are the current official guidelines regarding COVID-19 vaccination for patients with cancer or for hematologic conditions?
There are a number of resources available to guide clinicians on these decisions. I recommend the COVID-19 Resources webpage curated by the American Society of Hematology (COI, I'm the editor of that website). https://www.hematology.org/covid-19 This website includes guidance on immunizations in the...
Do you consider an ovarian cancer patient who progresses on PARP inhibitor, either for treatment or maintenance, to be platinum resistant regardless of time since last platinum based chemotherapy?
I would not necessarily. The time since the last platinum is what would drive my answer. It may pan out in fact that the patient is no longer platinum sensitive, but I would not make that determination based on an assumption that progression on PARP = platinum resistance. Although we do say that pla...
How would you manage a recurrent endometrial cancer confined to the vaginal cuff that is completely resected?
At this point, unless there is contraindication to EBRT, we favor the combination of EBRT plus HDR brachy.
How do you manage a cervical cancer that needs interstitial brachytherapy with prolonged thrombocytopenia after concurrent chemoRT?
Although infrequent, we have done pre op plt transfusion to make brachytherapy feasible and to avoid prolonging the total duration.
Do you consider high para-aortic nodes above the renal vessels to be locally advanced or metastatic in cervical cancer?
It sounds like you are asking how aggressively to treat patients with para-aortic nodal spread. My limit for "para-aortic" or "regional LAD" is usually anything below the diaphragm. I generally think of and treat these patients as advanced stage III.I would also advocate for definitively treating ce...
How do you approach staging for a patient with adult granulosa cell tumor, grossly confined to one ovary, and desiring a fertility sparing procedure?
A fertility sparing approach may be considered in this patient as long as a restaging surgical procedure demonstrates no obvious evidence of metastatic disease. The procedure should include a careful inspection of peritoneal surfaces, peritoneal biopsies, and partial omentectomy. Systematic pelvic a...
After an optimal tertiary cytoreduction for recurrent granulosa cell tumor previously treated with BEP and hormonal therapy, would you recommend systemic chemotherapy?
Yes, I would give adjuvant therapy. I would go with carbo taxol. The MD Anderson people have been using this regimen for some time. It is less toxic and appears to be as active as BEP. I think Jubilee Brown published a paper on this subject recently. This exact meeting was not specifically addressed...
How would you manage a patient with history of stage IIIC HGSOC after secondary cytoreduction of isolated inguinal node recurrence 12 years after primary treatment?
Difficult case. Could just observe if the lymph node is an isolated recurrence with no extracapsular extension. If extracapsular extension, could offer standard chemotherapy again, or just single agent carboplatin to minimize side effects x 6 cycles. This patient should have been extra-sensitive to ...