Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you approach RT coverage of an abdominopelvic lymph node in the oligometastatic or oligorecurrent setting?
Speaking specifically about prostate cancer, after treating a number of these with SBRT and having them fail in an adjacent node, me and everyone in our group will tend to treat the entire nodal chain with an SIB to the grossly involved LNs. The only exceptions are in those patients where prior RT p...
In uterine cancer, how does positive peritoneum biopsy influence your recommendation for adjuvant RT?
It is stage IV disease and routine value of any adjuvant RT is very limited.
When do you consider the insertion of nephrostomy tubes for gynecologic malignancies without fistulas?
I agree with Professor @Dr. First Last, in addition, bilateral hydronephrosis, cortical thickness intermediate for imminent renal function decline, and treatment (chemoradiation) is planned, nephrostomy tubes can be considered. In some cases, inflammation from radiotherapy (obstructive uropathy) and...
When the initial diagnosis of stage I uterine leiomyosarcoma is made via a non-intact resection such as a myomectomy or supracervical hysterectomy, what factors, if any, might push you to consider adjuvant chemotherapy after completion surgery?
Great question. Delivering a non-intact uterus has been investigated and reported over the past several years. Specifically, it has been reported in the context of uterine morcellation and the prognosis of those surgeries that morcellated sarcomas compared to those that the uterus was delivered inta...
What elective nodal areas do you cover in medically inoperable endometrial cancer?
Gebhardt et al., PMID 28923412 Schwarz et al., PMID 26186975 For early stage grade low volume grade 1 and 2 treated with brachy alone like the above reference. For those who need EBRT (for large volume or high grade), I usually treat common iliac, external, internal, and obturator nodal regions.
What is the treatment strategy for a resected atypical endometriosis mass in the parametrium that has grade 1 endometrioid adenocarcinoma, in patient who had prior elective hysterectomy/BSO?
Based on the information, would favor pelvic RT unless high risk from adhesions from endometriosis as adjuvant treatment.
What is your approach to first line systemic treatment for low risk gestational trophoblastic neoplasia?
Patients with gestational trophoblastic disease and a WHO score < 6 are classified as low risk. In patients who desire retention of fertility, the first line treatment is chemotherapy which achieves typically very high remission rates/cure rates. The most frequently used first line regimens employ m...
Would you offer radiation to a patient with extensive vulvar dysplasia not amenable to surgical resection and previously resected micro-invasive vulvar cancer in the setting of immunosuppression for solid organ transplant?
I have never done RT for dysplasia alone in the absence of invasive disease so would avoid it and try other means and keep on close follow up.
How would you approach the primary treatment of a rapidly growing uterine carcinosarcoma with local extension through the anterior abdominal wall?
This patient needs multimodal therapy - surgical resection is a mainstay of treatment followed by adjuvant therapy (most likely chemotherapy +/- vaginal brachytherapy). In terms of chemotherapy agents - up front adjuvant treatment is usually carboplatin/paclitaxel or ifosfamide/paclitaxel. I would p...
How would you manage an endometrial adeno abdominal wall recurrence at the port site from prior laparoscopic surgery?
I agree with R0 resection and would echo postoperative RT if it is the only site of disease. Oncologic abdominal wall resections are not routine for most surgeons and don't have standardized approaches. Make sure that your surgeon and pathologist understand that you want it evaluated similarly to a ...