Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
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 approach to post-operative prophylactic anticoagulation for patients undergoing minimally invasive surgery for gynecologic malignancies?
Recommendation:This is a great question; one our group has recently been discussing. My current practice is to advise patients with gynecologic malignancies undergoing minimally invasive surgery (MIS) to receive extended prophylaxis (4-week course of apixaban) depending on individual risk factors. A...
Is peritoneal dialysis a contraindication to pelvic radiotherapy?
I have never done it except for a few patients with palliation as treating the entire pelvis may increase the risk of complications of dialysis and also may decrease efficacy and with changes in peritoneal permeability unless treating localized field like prostate or below the peritoneal reflection....
What is your approach to adjuvant treatment for stage IA small cell carcinoma of the ovary, hypercalcemic type, after fertility sparing surgical staging?
Due to the rarity of small cell carcinoma of the ovary hypercalcemic type (SCCOHT), limited prospective data exists to inform treatment decisions. Like other malignancies in the malignant rhabdoid tumor (MRT) family including renal and extra-renal MRT and atypical teratoid rhabdoid tumors (ATRT), SC...
Does the presence of an ATM mutation in advanced stage ovarian cancer influence the decision to use Bev vs PARP inhibitor for maintenance?
I would not use the presence of an ATM mutation alone to inform decisions between bevacizumab vs PARPi maintenance. There are several options for maintenance in the 1L setting, and these include single agent PARPi, PARPi + bevacizumab, or bevacizumab monotherapy. Using data from the PAOLA-1 trial, i...
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