Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Is there a role for SBRT with vaginal melanoma?
With proximity of rectum, urethra, and vulva, we favor 3DCRT or IMRT to 45-50 Gy at 2.5 Gy per fraction with and without brachy based on response.
Would you treat a vulvar SCC with definitive chemoRT with 50.4 Gy IMRT then boost the GTV with en face with electrons to ~6400?
There is no "one fits all" for vulvar cancer, which is a complex disease with varying disease presentations. The ideal method of boost and the dose depends on the size, location, histology, and other factors. We used to use en face electron boosts much more frequently before we began using IMRT. It ...
Would you alter neoadjuvant chemotherapy regimen for a high grade small cell neuroendocrine carcinoma of the ovary if she has already received cycle 1 of carbo/taxol?
Small cell neuroendocrine tumors of the ovary are rare and of poor prognosis. There are several steps I would take in a situation like the one described in the vignette. Discuss poor prognosis with the patient. Rule out occult primary that is not ovarian. Get early involvement of medical oncologis...
How would you adjust therapy for a patient with high risk, stage III choriocarcinoma (lung mets) in the context of renal insufficiency (Cr 3.8)?
Risk score might dictate chemo regimen. There are dose adjustments for Methotrexate & Cytoxan based on renal function for MAC which you could use if risk score 7 or 8. I’d follow MTX levels & dose folinic acid until nontoxic MTX levels. If higher score I’d use EMA +/- CO. Consider neupogen on off-ch...
How do you manage cancer treatment-related cognitive change or "chemo brain?"
Chemo-brain is a vexing and complicated diagnosis. In most cases, you don't know the baseline neurocognitive function of individuals with cancer. Many conditions that are associated with chemotherapy like fatigue, depression, and aging can mimic chemo-brain. Estimates are that about 20% of individua...
What chemotherapy would you utilize for a metastatic dysgerminoma diagnosed in the second trimester of pregnancy?
Cisplatinum, Etoposide, Bleomycin
Would SBRT be recommended for a non-surgical isolated para-aortic recurrence in the setting of metastatic papillary serous ovarian cancer residual disease after systemic therapy?
There are multiple retrospective single institution and combined multi institutions studies showing RT in this setting (either SBRT or regional IMRT based on clinical scenario and nodal recurrence pattern) leads to excellent index cancer control. It prolongs chemotherapy free interval and progressio...
What recommendations are you giving when patients ask about the best 'cancer diet' to be on?
I counsel patients that there is no definitive data on "cancer fighting foods." What we do know is that nutrition is important for patients undergoing active cancer treatment and involving nutrition can be helpful - and is in fact, a component of many geriatric assessment intervention trials. Resear...
What is your approach to immunotherapy-related pancreatitis?
Depending on the severity of the ICI-associated pancreatitis, I will start patients on prednisone 0.5 mg/kg/day - 1 mg/kg/day. Once lipase levels decrease and approach normal levels, I will start tapering at generally around 10 mg weekly with a total taper time that is typically close to 6 weeks. If...
What strategies have you found to be most effective in engaging PCPs in a primary-care or shared-care model of survivorship for pediatric and AYA patients who will receive ongoing care in their communities away from their primary oncology treatment site?
This is a challenge for our center, and many other centers as well. The ideal approach would be to have adult primary care physicians associated with our center who have dedicated clinic time to care for cancer survivors, direct access to our expertise and medical records. While we haven't been succ...