Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How would you proceed for a patient with metastatic gastric-type adenocarcinoma, with vaginal and inguinofemoral disease only, who experiences complete response to her vaginal tumor but residual inguinal disease?
There is no ideal data to guide this. I would recommend surgical nodal excision of the residual inguinal disease, followed by pelvic and inguinal radiation (with or without platinum if the patient can tolerate further). Another approach would be with cisplatin-based chemoradiotherapy with treatment ...
Would you give adjuvant therapy after diagnosis of presumed stage IA, 5cm, ER/PR+ uterine adenosarcoma on a total hysterectomy with bilateral salpingoopheretomy without staging?
We would favor observation with no adjuvant treatment.
How do you approach a metastatic juvenile granulosa cell tumor of the ovary in a premenopausal patient following a hysterectomy and USO with the remaining ovary in situ?
In this patient who does not desire fertility (as she is s/p hysterectomy), I would recommend completion surgery with USO, omentectomy, removal of any residual peritoneal disease, assessment of lymph nodes and removal if abnormal. Would recommend platinum-based chemotherapy after surgery and reserve...
Do you offer PARP inhibitor maintenance retreatment of platinum-sensitive, relapsed, high grade serous ovarian cancer in patients who had a complete response to their most recent platinum-based chemo?
For patients with platinum-sensitive relapsed ovarian cancer with a partial or complete response to platinum-based chemotherapy, PARP inhibitors niraparib, olaparib, and rucaparib are approved by the FDA for maintenance therapy. These patients were not treated with prior PARP inhibitor therapy in th...
What is the rationale for 6 hours between EBRT and HDR fractions for BID treatment?
Based on half-life of repair of about 1.5 hours for most normal tissue (spinal cord is one of the exceptions). So 6 hours will be 90% repair with 4 half-life intervals.
In which patients with oncologic or hematologic disorders are you recommending a 3rd dose of mRNA COVID vaccine?
In the ideal world, we would tailor the need for booster shots based on whether or not a patient achieves an appropriate immunologic response and maintains that response for long periods of time. This would include both seroconversion and T-cell-mediated immunity. However, we have neither routine no...
What is your approach to the management of hot flashes in a patient who wants to use herbal medicine?
Hot flashes are so bothersome to some postmenopausal women, especially those with breast cancer in whom we discourage the use of estrogen or potentially estrogenic, that we now have evidence from randomized trials to help guide treatment. With regard to nonprescription therapies, data thus far suppo...
Would you add a PARP inhibitor to bevacizumab maintenance for a patient with a high grade serous ovarian cancer with a germline BRCA2 variant of unknown significance and negative somatic testing?
The information above is insufficient in informing a treatment recommendation. As defined, the implications of the BRCA2 VUS are unclear. In this setting, I would advocate that HRD testing be performed on the tumor tissue. If the tumor is HRD+, I would certainly counsel the patient on the utility of...
Would concurrent endocrine therapy and PARPi maintenance be safe and appropriate after surgical treatment/adjuvant chemotherapy for a patient with BRCA1 mutated synchronous early stage HR+ breast CA and Stage IIA Fallopian tube carcinoma?
This does seem like a reasonable approach, based on my knowledge of eligibility criteria and tolerance in the OlympiA trial, which was a randomized trial of olaparib vs placebo in BRCA mutation carriers. In the OlympiA trial, patients with BRCA 1/2 mutation and hormone receptor positive breast cance...
What is your strategy to help prevent paclitaxel-related neuropathy?
There are no proven strategies for prevention of CIPN and the use of these supplements is not recommended. Some supplements such as acetyl carnitine can actually worsen neuropathy outcomes and some supplements such as B12, vitamin C, and others may negatively interact with chemotherapy and worsen di...