Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you manage post radiation chronic vaginitis with bleeding?
Limit trauma to the area. No biopsies unless absolutely necessary. Can use vaginal packs on a short term basis (don't leave in too long). Transfusions if indicated. Can try a course of metronidazole, which can treat an anaerobic infection, but also is purported to have oxygen-mimetic properties. Thi...
Do you recommend adjuvant radiation for a recurrent pT1bN0 vulvar carcinoma?
For recurrence disease, if the depth of invasion is more than 1 mm and nodal assessment is not done then would favor/discuss RT. Data shows with each recurrence, risk of nodal involvement (15%) goes up which is hard to salvage Grootenhuis et al., PMID 26428940.
How do you manage a patient with BRCA1 mutation with stage IVA high grade serous ovarian carcinoma following complete cytoreduction and adjuvant chemotherapy, currently on PARP inhibitor maintenance, found to have residual suprafascial disease on pathology following ostomy reversal?
This is a situation much like an elevated Ca125 where the patient is 1) asymptomatic and 2) has NED on imaging but has disease present. The decision to stop the PARP inhibitor and start traditional chemotherapy would have to be a risk/benefit decision with the patient. The evidence of disease at the...
How do you manage an inoperable T1b1 N1 M0 Cervix adenocarcinoma which developed 6 years after treatment of a rectal adenocarcinoma s/p LAR with adjuvant posterior pelvic radiation and chemotherapy?
There is no one answer but for central area, I would do brachy alone using IGBT with a dose of 7.5 Gy x 5 to HRCTV but aiming d98 GTV 95 Gy and above if possible based on rectal and bladder dosimetry.
What is your adjuvant treatment approach to patients with stage IC1 clear cell carcinoma of the ovary (intraoperative rupture)?
I would offer 6 cycles of adjuvant chemotherapy for a clear cell cancer with intraoperative rupture. I would not observe a clear cell tumor. I would also want to know if this patient was completely staged because this would change the prognosis.
How would you approach a vulvar SCC with extension to the anal sphincter and inguinal nodes, 10 years after definitive chemoRT+brachy for a cervical cancer?
I have treated few in this situation. Limited to treating vulva, anal canal with the inguinal region with boost to GTV to 66 Gy EQ2 dose with concurrent cisplatinum, avoided any prophylactic nodal region including mesorectum or pelvic nodal region.
For a patient with adenosarcoma of the ovary with high grade sarcomatous overgrowth removed intact with appropriate oncologic surgery, is there any role for radiation?
I don't see a role for adjuvant RT in this case. Should she develop a pelvic-only recurrence, then RT would be an appropriate modality.
What intracavitary brachytherapy dose (and fractionation) would you recommend for stage I vaginal cancer post-resection with positive (R1) margins?
Presuming nodes have been addressed or don’t need to be addressed. For brachy alone cases, I have done 6 Gy x 6 to GTV area with MRI planning with the first 4 or 5 fractions treating longer length especially if has VIN for microscopic dose and disease.
Would you alter your treatment algorithm for uterus mesonephric-like adenocarcinoma?
Very rare entity and would follow management principles for high grade (g3) endometrial cancer.
Given the platinum drug shortage and the recently presented NOW trial, would you consider PARP inhibitor use in place of platinum-based chemotherapy for advanced ovarian cancer?
The NOW trial results are extremely exciting and add to the growing body of data challenging the traditional upfront platinum treatment paradigms in ovarian cancer. However, without randomized data comparing PARPi to platinum/taxane-based treatment, I would not yet utilize PARPi monotherapy in the n...