Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
If blood counts are being checked during concurrent chemoradiation, is there a number at which point you would recommend a radiation treatment break?
I’ll let the platelets go as low as 10K before stopping. I lean heavily on the rate of decline to intervene with a break sooner than the absolute numbers if heading for trouble and later if decline is slow and at reaching the end of treatment.
Should special precautions be taken patients with Ehlers-Danlos syndrome receiving radiation therapy?
Not all EDS is the same. Most commonly, an EDS patient these days is a clinically diagnosed patient with hypermobile joints, possibly stretchy skin, and possibly chronic pain syndrome. That is a very different picture from vascular EDS with a COL3A1 mutation, which is rare and would have the extreme...
In your practice, what is your goal dose for boosting positive PA nodes in either the adjuvant or definitive treatment for cervical cancer?
The dose of RT is based on the risk of tumor recurrence tempered by normal tissue constraints. In general, known or suspected gross nodal disease is treated to 60 Gy; higher doses of 62-66 Gy may be used for large nodes that are not immediately adjacent to the duodenum, particularly if a portion of ...
In a female patient in her 50s with ovarian cancer who developed a whole-body rash and lip swelling 7 days after her first cycle of carboplatin, paclitaxel, and bevacizumab, how would you proceed with pretreatment for cycle 2, assuming this was a delayed reaction to carboplatin or paclitaxel?
It is very important to characterize any delayed rash after treatment with its timing, morphology, severity, and whether features of a severe cutaneous adverse reaction are present. A benign delayed rash is the most common scenario and can generally be treated with symptomatic management and enhance...
How would you define the role for radiation in the management of a primary vulvar leiomyosarcoma in close proximity to anus?
Favor surgery followed by RT unless not operable without compromising anal function.
What screening tools or signs do you use to predict if a cancer patient is near end-of-life?
For most of us, long-time practicing oncologists, all we have to do to determine that one of our patients is at the end of their life is to be in the same room with them. No special computer programs or calculators are needed. Just look closely at the patient's current weight, their level of conscio...
How would you approach a pre-viable pregnant patient in the second trimester with metastatic ovarian cancer who wants to keep the pregnancy?
I would recommend neoadjuvant chemotherapy and co-manage with maternal-fetal medicine to try to optimize the outcome for both mom and baby. Typically, we will start chemotherapy (platinum-based) after organogenesis is complete and continue q21 days until about 3-4 weeks before planned delivery. Once...
Would you consider radiation alone or chemoradiation therapy for a small vulvar cancer near the urethra or clitoris?
Yes, I think radiation is worth considering in this situation. However, the morbidity of radiation is also significant with potential for edema and fibrosis in high dose volume. The consequence of that may arguably be worse than surgery. If we do treat with radiation, I would still add chemotherapy ...
What dose is required to gross disease in the definitive treatment of vulvar cancer?
As with all gynecologic carcinomas, the optimal dose is at least to some extent dependent on the volume of disease. However, our experience suggests that a minimum of 60 Gy should always be given for gross diasease, even when concurrent chemotherapy is being given. That said, for gross disease that ...
Which patients with locally advanced cervical cancer would you consider as candidates for moderately hypofractionated pelvic chemoradiation before brachytherapy?
At present, would not offer outside clinical trials, as data are limited, with some suggesting a higher risk of acute morbidity also. Doses of EBRT in these studies are also not similar, varying from 37.5 in 15, 40 in 16, 44 in 20, and 43.3 in 17.