Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Is it acceptable to treat vulvar cancers with split course radiation?
Unless the planned course is for palliation, split course is not suggested.
When is pelvic lymph node dissection indicated in vulvar cancers?
GOG 37 established adjuvant RT to pelvis and groins better than PLND for inguinal node positive patients. Pelvic recurrence rates were similar in both arm with the predominant difference being in inguinal recurrence. PLND as part of routine management in vulvar ca is hardly indicated.
How would you counsel a patient regarding possibility of ovarian preservation at time of surgery for malignant mesothelioma initially discovered in a myomectomy specimen and involving peritoneal surfaces?
If the mesothelioma is on the lower grade of the spectrum and the margins negative, I would offer fertility preservation if feasible at surgery. If high grade, I would have a discussion about prognosis with the patient. If all the tumor can be resected with an R0 resection, it should be offered - th...
What is your approach to adjuvant therapy for stage IC low grade serous ovarian cancer s/p full staging with R0 resection?
As reported in the literature, low-grade serous ovarian cancer is not as chemo-sensitive as high grade histology, and the main predictor of survival is successful cytoreduction. In patients with stage Ia, IB I usually recommend surveillance and for patients with stage IC, I would discuss hormonal th...
How do you counsel patients who are candidates for a clinical trial regarding their options?
I typically discuss the option with patients as early as possible in their diagnosis, and explain that at some point during their treatment they may become a candidate for a clinical trial. I discuss resources to look into clinical trials and what they mean for patients. We discuss patient website r...
When might you recommend adjuvant chemotherapy for fully staged/resected stage IA clear cell ovarian carcinoma?
Clear cell carcinoma of the ovary is one of the less common forms of ovarian cancer and is considered a high-grade tumor. It has a higher risk for recurrence and a poorer prognosis as compared to some other forms of ovarian cancer. For that reason, adjuvant therapy with platinum based chemotherapy i...
How would you manage a patient with recurrent granulosa tumor following secondary, R0 cytoreduction, and negative inhibins postoperatively?
If inhibin was a useful marker for recurrence, I think it is acceptable to observe without further therapy, particularly if time to recurrence was prolonged. However, adjuvant therapy with paclitaxel/carboplatin would also be a good option.
How do you advise patients on duration of first line maintenance PARPi and the potential risk of MDS or AML?
For patients, who could derive significant survival benefit from first line maintenance PARP-inhibition (BRCA+ and HRD tumors), we advise them to take PARP-inhibitors up to 2 years (olaparib) or up to 3 years (niraparib) if no disease progression or unacceptable toxicity. I counsel patients that dev...
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...