Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
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.