Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Do you personally review all imaging you order or rely judiciously on radiologist interpretation?
In my practice, I do like to review the images and the reports for all the studies I order. While I trust my radiology colleagues, I find reviewing the images myself helps both my patients and my own understanding of the disease process. For operative patients, I like to look when the study is initi...
How do you typically sequence chemotherapy and palliative radiation for metastatic endometrial and cervical cancers?
We have done it either way. Either start with RT for pain control or do it in between chemo based on the OAR dose and fractionation planned. If away for critical OAR dose and plan for single fraction, it can be done in between chemo also.
Would you order a DEXA scan for a cervical cancer patient with osteoporosis?
This is a great question and one that we should all be contemplating. I do order Dexa scans on all of my post-menopausal patients if they have not had a current baseline. Many of them have lifestyle issues that could also have decreased bone density such as low weight, tobacco and alcohol use, etc. ...
Do you routinely use prophylactic anticoagulation when treating ovarian cancer patients with neoadjuvant chemotherapy?
There are currently no standard guidelines regarding VTE prophylaxis in patients undergoing neoadjuvant chemotherapy (NACT) for ovarian cancer. ASCO recommends against routine use for patients receiving chemotherapy who are at average risk, but "suggest" prophylaxis in patients at high risk.Retrospe...
Does the risk of bowel complications change in a case where there is bowel invasion in a non functioning portion of sigmoid after diversion in a gynecologic malignancy getting CRT + brachy?
The type of bowel complications would define the risk of being symptomatic. Diversion will help with the future risk of fistula but the patient can still develop symptomatic necrosis. That being said, I would prioritize cure in this situation as persistent disease would cause more symptoms.
For a localized vaginal cuff recurrence of uterine leiomyosarcoma, what is the preferred management strategy?
I would favor surgery if feasible (upper vaginectomy is also sometimes an option) and if not, can try induction chemo or preop RT to make it resectable.
How do you optimize definitive external beam pelvic radiation in a patient with cervical cancer that is unable to fill her bladder due to bilateral percutaneous nephrostomy tubes?
It’s better to treat with an empty bladder as it is reproducible for this scenario and reduces the uncertainty of the uterus and cervix position. The total dose is only 45 Gy in 25 fractions so within the limit of organ tolerance.
After seeing results from GOG238, is there a subset of patients that might still benefit from chemoradiation for centrally recurrent endometrial cancer?
It’s hard to know who would benefit but use for bulky or high grade central recurrence. Bulky is subjective but usually for lesions that are more likely to need interstitial brachytherapy.
Would you ever start adjuvant pelvic radiation with a drain in place?
I wait for the drain to be removed as it’s in the target location.
What dose and fields would you use for basosquamous carcinoma/basal cell carcinoma of the vulva s/p WLE but not fully excised due to adhesion to the rectum, with no further surgery offered?
If pure basal cell, I would focus on the primary only.