Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Do you recommend progesterone for endometrial protection in a young woman on estrogen replacement therapy for iatrogenic menopause after definitive radiation therapy for locally advanced cervical cancer?
For women with a uterus, I give a combination of estrogen and progesterone therapy, even after definitive radiation therapy. Transdermal preparations have the advantage of bypassing first-pass effect of the liver, but oral combinations are also acceptable.
In patients getting concurrent chemo-immunotherapy for locally advanced cervix cancer, would you hold immunotherapy during the 2.5-3 weeks of brachytherapy?
Pembro is continued throughout the course of treatment. Initially, every 3 weeks for 5 cycles with concurrent chemo RT plus brachy and then every 6 weeks for 15.
When do you initiate vaginal cuff brachytherapy treatment after hysterectomy for early stage endometrial cancer?
We usually start vaginal cuff treatment 5-6 weeks after hysterectomy. If adequately healed, may start at 4 weeks but not before. Rarely more than 8 weeks. For patients receiving vaginal cuff treatment plus chemotherapy, we still give cuff treatment within 6 weeks. There is no reason to delay because...
When treating endometrial cancer patients with a combination of chemotherapy and vaginal cuff brachytherapy, when do you deliver cuff brachy?
I prefer, most of the time, between the cycles of chemotherapy (1 to 3) based on logistics.
Are you altering your use of immune checkpoint inhibitors given the risk of immune-related pneumonitis and the COVID-19 outbreak?
Nivolumab can be used every 4 weeks rather than every 2 weeks. We have to be flexible and change our approach according to circumstances.
What are your top takeaways in Gyn Cancers from ESMO 2025?
Studies presented at ESMO 2025 give a glimmer of hope to patients with platinum-resistant ovarian cancer, an area of gynecologic oncology where too little progress has been made. There were also numerous trials (too many to discuss here) presented involving ADCs, along with important updates to prev...
What is the optimal interval between vaginal cuff brachytherapy sessions?
At MD Anderson, we give 6 Gy x 5 to the surface and we most often treat every other day. However, given the low risk of toxicity, we think it's safe to make adjustments to this schedule. For example, we often do some treatments on sequential days if that's preferred for any reason. We also schedule ...
Have you had patients who wish to take ivermectin and/or fenbendazole as adjunct treatments for gynecologic cancers, and if so, how have you handled this?
Since COVID, there are definitely more patients interested in ivermectin and/or fenbendazole, as well as other alternative therapies. I will counsel the patients on the data for standard of care therapy, but also acknowledge that it is also their body, their life, and ultimately their choice what tr...
How do you explain the use of an AI scribe to patients the first time it is used in their care?
In residency, we had to get patient permission to videotape sessions and allow our supervisors to watch sessions from behind a one-way mirror. If I were to use a scribe, especially an AI scribe, or if I were audio or video taping the sessions, I would definitely want to get a patient’s approval. I d...
How do you determine the choice of therapy for platinum resistant ovarian cancer in healthy, good performance status patients?
Platinum-resistant epithelial ovarian cancer is generally defined as relapse less than 6 months following completion of primary or the last platinum-based chemotherapy regimen. Options for therapy include conventional, commercially available drugs or potential clinical trials. If prior genetic testi...