Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Would you use a PARP inhibitor as treatment for recurrent platinum-sensitive ovarian cancer with a RAD51 (or other moderate-penetration HRD germline) mutation?
Of course
How would you manage radiation cystitis in a vulvar cancer patient still receiving EBRT with known history of cystocele and who is otherwise hemodynamically stable?
For me, this is a very confusing question. First, I am not sure what is meant by "radiation cystitis." The question seems to imply that the patient is having hematuria as a component of the radiation cystitis diagnosis. In my long career, I have never seen a patient have noticeable hematuria during ...
What is your recommended radiation field in early stage vulvar cancer (T1a-b) with myelosuppression, inconclusive SLNBx, and persistent positive margins?
Would favor vulva and bilateral groin (limit to medial groin to reduce marrow exposure of femoral region).
Would you have any concerns about giving pelvic radiation in someone with a previous history of receipt of HIPEC?
I have done it a few times but important to know pelvic adhesions at the time of surgery to counsel better about the risk of SBO (pros vs. cons).
What is your approach to adjuvant vaginal cuff radiation in patients with prior definitive pelvic radiation therapy?
I do take the previous dose into account. Sometimes use a multichannel cylinder and try to control the rectum and bladder dose. Also, prescribe lower end of acceptable dose schedule like 6 Gy x 5 to surface or 4 Gy x 6 to surface.
How would you sequence treatment of a synchronous IC1 high-grade serous ovarian cancer and cT3N1 rectal cancer?
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...