Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Has your preferred adjuvant treatment for IC mucinous ovarian cancer changed in response to the platinum chemotherapy shortage?
We previously offered observation to Stage IC low grade mucinous ovarian cancer so this has not impacted our decision.
How should PARP inhibitors be incorporated into clinical practice in later line/maintenance of platinum-sensitive ovarian cancer for PARP inhibitor-naïve patients?
Personally, if I have a PARPi naïve recurrent platinum-sensitive patient, I would have no hesitation in treating them as we did in these trials. The OS data and FDA action on the prior indications, in my opinion, was a reckless statistical exercise and potentially harmful to patients.
What outcome data do you view as most impactful to make treatment decisions regarding the use of PARP inhibitors in later line or recurrent ovarian cancer?
The crossover makes the OS data very hard, if not impossible, to interpret. The findings were not that parps for platinum sensitive maintenance for non-BRCAm were detrimental -- it was that they did not seem to show OS benefit. Certainly, treatment free intervals and quality of life are extremely im...
How do you counsel patients with homologous recombination repair proficient tumors already on niraparib maintenance therapy, prior to the FDA restriction?
In the NOVA trial, the PFS benefit for the BRCAwt/HRP patient sub-group was approximately 3 months. Given this small improvement in PFS, prior to the FDA restriction, I always had a risk/benefit discussion with patients reviewing this small benefit and whether the benefit outweighs the risks of trea...
In patient s/p definitive chemoRT for vulvar cancer with complete response, how do you manage a non-healing vulvar defect if biopsy is negative for residual disease?
Hard and takes time. Vitamin E with trental and quit smoking.
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.