Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Do you have any precautions to your injury to the uterine artery when placing interstitial needles as ‘ovoid extenders’ to cover parametrial disease in cervical T&O procedures?
When using oblique needles, it does come close to parametrial vessel, and the risk of bleeding is increased. Some use Doppler ultrasound to identify and avoid needles in vessels. What we do is tend to usually not push the oblique needle beyond 2 cm and adjust later on CT if needed and take precautio...
How do you approach hormone replacement therapy for premenopausal patients following pelvic radiation therapy?
Most patients who undergo pelvic radiation will become menopausal. Physiologically, the outcome is similar to surgical menopause because sufficient doses of radiation result in complete loss of ovarian function. In contrast, after natural menopause, the ovaries continue some types of endocrine funct...
For cervical cancer intracavitary brachytherapy, do you use contrast when using CT-based planning to better visualize the ureters?
We normally do MRI based planning and the ureter can be identified and contoured on MRI. For only CT based, we do out diluted contrast in bladder for bladder contouring but do not go to the ureter. Rodríguez-López et al., PMID 33065181Koerner et al., PMID 34980569
For a patient obtaining significant benefit and no side effects from pentoxifylline/Vitamin E for radiation-induced vulvovaginal fibrosis, do you continue treatment longer than 6-7 months or discontinue?
I reassess these patients at 3 and 6 months, regardless of site (gyn or breast). If the patient is benefitting from the trental/vitamin E but still has significant fibrosis, I continue these meds for up to 2 years.
Would you cover presacral lymph-nodes in endometrial cancer patients with locally advanced disease (IIIC2 disease) who received neo-adjuvant chemotherapy prior to resection with no residual disease on pathology?
For IIIC2 endometrial cancer, we have included presacral lymph nodes routinely. There are no studies to compare with and without presacral lymph to my knowledge.
When, if ever, would you consider deep venous thrombosis prophylaxis for patients with advanced epithelial ovarian cancer undergoing neoadjuvant chemotherapy?
The Khorana scoring system is a great tool when this question comes up. I use it for all my ovarian cancer patients who have measurable disease in the neoadjuvant and adjuvant settings. I re-evaluate their score every 3 months to ensure they are still candidates for VTE ppx. Mulder et al., PMID 3060...
For patients with metachronous isolated oligometastatic cancer of gynecologic origin to the supraclavicular fossa, do you prefer standard fractionation therapy to cover the entire supraclav or SBRT to the involved nodes?
Have preferred treating the entire region with sib boost to node.
How would you approach HDR portion of cervical SCC with large area of fistula with sigmoid colon?
Consider using ultrasound every time a tandem is inserted or a Smit sleeve placed under ultrasound guidance (if not already part of routine practice) for tandem guidance, to ensure that a false tract into the fistulous bowel is not produced at the time of tandem placement. Otherwise, as noted by Dr....
When would you consider tapering glucocorticoids in a patient with ICI-associated myocarditis?
Once troponins start to decrease, I start the steroid taper and follow troponin levels. If they rise, I slow the taper. I also get serial ECGs, esp if there were arrhythmia manifestations of myocarditis. Don't forget to assess for the need for PJP prophylaxis with Bactrim or pentamidine and PPI sinc...
When treating locally advanced cervical cancer with concurrent chemoRT, do you contour the presacral LNs to the bottom of S3 or you stop your contour at S2-S3?
We contour up until we start seeing pyriform muscle like contouring guidelines for gynecological cancer. We address the differences between prostate and gyne in this letter Musunuru et al., PMID 33610294