Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How would you manage a large grade 2 endometrial adenocarcinoma with invasion into the parametria and upper vagina without nodal or metastatic disease?
PETCT and MRI. Preoperative chemo RT with EBRT plus brachy followed by surgery. Vargo et al., PMID 25218303
What chemotherapy would you consider to treat platinum resistant high grade serous ovarian cancer in patients with a low grade MDS from prior platinum/PARPi?
Before making a recommendation to this patient, a basic understanding of treatment related MDS/AML is needed, along with a clarification of the meaning of “low risk of progression to acute myeloid leukemia (AML)”. My main goal would be to avoid therapy with a demonstrated risk of treatment related M...
Is it necessary to include entire lymphocele in CTV while treating post operative nodal sites of pelvic malignancy?
I don’t know if necessary or not but I tend to include it if can do it safely. If large and pathological node was negative, then skip to reduce dose to OAR.
When a patient with a preexisting rheumatic disease and on immunotherapy begins to flare, how do you decide if this is an underlying rheumatic disease activity versus an immunotherapy related adverse event?
If the symptoms/signs are similar to their prior flares of their rheumatic disease, then it is likely a flare. Over 50% of patients with autoimmune diseases flare on immune checkpoint inhibitor therapy if you look at systematic literature reviews of the limited published data. If symptoms are unrela...
Would you consider definitive radiation therapy (EBRT + interstitial HDR) in lieu of pelvic exenteration for a vaginal spindle cell sarcoma?
I would not favor definitive RT unless not a surgical candidate but sometimes have been able to do EBRT plus brachy after gross total excision to avoid exenteration.
Would you consider adding adjuvant vaginal cuff brachytherapy for a FIGO 1A endometrial cancer, G1, no LVSI, based on the presence of extensive lower uterine segment involvement?
It’s not an absolute indication for adjuvant brachy with small absolute benefit.
How would you proceed when a cervical cancer undergoing brachytherapy has exceeded the rectal dose but not met the target dose?
Rectal dose and target dose have range. Preferred rectal dose for D2cc < 65 Gy but can accept up to D2cc < 75 Gy, provided you understand expected risk of complications with increased dose. Preference would be to do hybrid applicator with 3D imaging to optimize HRCTV and OAR.
How would you manage a dehiscent vaginal cuff 2 months after vaginal cuff brachytherapy?
It has to be a combination of surgery and radiation. Partial small dehiscence can sometimes be managed conservatively otherwise, most need surgical fixation.
How would you treat a recurrent ovarian malignant mixed Mullerian tumor on the pelvic side wall?
I would treat with IMRT and IGRT with total dose equivalent to 66 Gy based on OAR dosimetry to buy time without chemo and improve PFS.
What features help distinguish thyroid myopathy from immune checkpoint inhibitor-associated myopathy?
Immune checkpoint inhibitors (ICIs) can cause myositis (ICI-myositis). Since ICIs can also induce hypothyroidism, myopathy secondary from hypothyroidism can also be associated with ICI therapy. Different from thyroid myopathy, patients with ICI-myositis barely have myoedema or muscle pseudohypertrop...