Patterns of Care for Radiotherapy in Vulvar Cancer: A Gynecologic Cancer Intergroup Study

2009 ◽  
Vol 19 (1) ◽  
pp. 163-167 ◽  
Author(s):  
David K. Gaffney ◽  
Andreas Du Bois ◽  
Kailash Narayan ◽  
Nick Reed ◽  
Takafumi Toita ◽  
...  
Keyword(s):  
Vulvar Cancer ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Neoadjuvant Treatment ◽  
Study Groups ◽  
Cooperative Groups ◽  
Computed Tomographic ◽  
Gynecology And Obstetrics ◽  
Initial Surgery ◽  
Individualize Treatment

Background:This study aimed to describe radiotherapeutic practice in the treatment of vulvar cancer in member study groups of the Gynecologic Cancer Intergroup (GCIG).Methods:A survey was developed and distributed to representatives of the member study groups of the GCIG, targeting the use of radiotherapy (RT) in vulvar cancer.Results:Thirty-two surveys were returned from 12 different cooperative groups. The most common indications for neoadjuvant RT include unresectable disease or International Federation of Gynecology and Obstetrics stage ≥III. For the neoadjuvant treatment of vulvar cancer, pelvic doses were 48.2 ± 5.0 Gy (mean ± SD). The upper border of the pelvic field was L4/5 in 4, L5/S1 in 12, and not specified in 4. Of 21 groups that perform neoadjuvant RT, 17 use concomitant chemotherapy and 4 individualize treatment. Weekly cisplatin was the most commonly used chemotherapy. For the neoadjuvant RT treatment of the inguinal region, doses were 49.9 ± 5.5 Gy (mean ± SD). Sixteen of 18 groups used computed tomographic simulation for planning. After initial surgery, the most common indications for RT included positive lymph nodes or positive margins. Chemotherapy was not routinely used after surgery.Conclusions:Doses of RT among GCIG members are similar; however, the indications for treatment, treatment fields, and use of chemotherapy differ somewhat between groups. This is likely due to the rarity of the disease. The lack of randomized trials may contribute to the absence of a broadly accepted standard. This underscores the importance of international cooperation as in GCIG to gather more reliable data for uncommon tumors in gynecologic oncology.

Disseminated tumor cells in bone marrow of patients with endometrial and cervical cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5598-5598
Author(s):  
Florin-Andrei Taran ◽  
Markus Wallwiener ◽  
Andreas D. Hartkopf ◽  
Christina Walter ◽  
Sara Brucker ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Bone Marrow ◽  
Clinical Outcome ◽  
Tumor Cells ◽  
Vulvar Cancer ◽  
Gynecologic Cancer ◽  
Prognostic Significance ◽  
Disseminated Tumor Cells ◽  
Gynecology And Obstetrics ◽  
Lymphangiosis Carcinomatosa

5598 Background: The presence of disseminated tumor cells (DTC) in the bone marrow (BM) of breast cancer patients is associated with poor prognosis. Several studies demonstrated that tumor cell dissemination may occur in gynecologic cancer and affect clinical outcome. The aim of our study was to evaluate the incidence of DTC and to assess their prognostic significance in patients with gynecologic malignancies. Methods: Bone marrow aspirates from 623 patients with primary endometrial (331), cervical (228), and vulvar cancer (64) undergoing surgery at the Department of Gynecology and Obstetrics, University Hospital, Tuebingen, Germany between November 2001 and May 2012, were included into the study. Disseminated tumor cells were identified by immunocytochemistry using the pancytokeratin antibody A45B/B3 and by cytomorphology. Results: Disseminated tumor cells were detected in 18% of BM aspirates from patients with gynecological malignancies. Incidences of DTC in endometrial, cervical, and vulvar cancer were 21%, 16% and 16%, respectively. The presence of DTC was associated with a lower tumor grade in endometrial cancer For patients with vulvar cancer, no correlation with established clinicopathological factors was observed. In case of cervical cancer, BM positivity was correlated with International Federation of Gynecology and Obstetrics stage, nodal involvement and the presence of lymphangiosis carcinomatosa. For all analyzed tumor entities, no association between BM status and clinical outcome could be observed. Conclusions: Disseminated tumor cells are a common phenomenon in solid tumors. However, only in cervical cancer DTC postivity was associated with advanced disease. The consequences for DTC positive patients have to be determined.

scholarly journals Synchronous gynecologic cancer and the use of imaging for diagnosis

2016 ◽  
Vol 62 (2) ◽  
pp. 116-119
Author(s):  
Camila Silva Boaventura ◽  
José Lucas Scarpinetti Galvão ◽  
Giovanna Milanes Bego Soares ◽  
Almir Galvão Vieira Bitencourt ◽  
Rubens Chojniak ◽  
...  
Keyword(s):  
Gynecological Cancer ◽  
Gynecologic Cancer ◽  
Imaging Evaluation ◽  
Surgical Specimen ◽  
Cervical Cancers ◽  
Gynecology And Obstetrics ◽  
First Case ◽  
Young Subjects ◽  
Gynecologic Neoplasms ◽  
Case Diagnosis

Summary Endometrial and cervical cancers are the most prevalent gynecologic neoplasms. While endometrial cancer occurs in older women, cervical cancer is more prevalente in young subjects. The most common clinical manifestation in these two gynecological cancers is vaginal bleeding. In the first case, diagnosis is made based on histological and imaging evaluation of the endometrium, while cervical cancers are diagnosed clinically, according to the International Federation of Gynecology and Obstetrics (FIGO). The authors present a case of synchronous gynecological cancer of the endometrium and cervix diagnosed during staging on MRI and confirmed by histological analysis of the surgical specimen.

scholarly journals Approach to Palliative Care Consultation for Patients With Malignant Bowel Obstruction in Gynecologic Oncology: A Qualitative Analysis of Physician Perspectives

2020 ◽  
Vol 16 (8) ◽  
pp. 483-489
Author(s):  
Claire Hoppenot ◽  
Fay J. Hlubocky ◽  
Julie Chor ◽  
S. Diane Yamada ◽  
Nita K. Lee
Keyword(s):  
Palliative Care ◽  
Qualitative Analysis ◽  
Bowel Obstruction ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Malignant Bowel Obstruction ◽  
Specific Patient ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Nonsurgical Patients

PURPOSE: Malignant bowel obstruction (MBO) from gynecologic cancer is associated with increased symptoms and short survival. A gynecologic oncologist’s approach to palliative care consultation in the setting of MBO has not been well studied—it could be an opportune time for collaboration with palliative care. MATERIALS AND METHODS: This qualitative analysis of interviews with gynecologic oncologists focuses on their perspectives on palliative care consultation at the time of MBO. Interviews were analyzed using a framework analysis, and key themes and quotations were extracted. RESULTS: We interviewed 15 gynecologic oncologists from 8 institutions in Chicago. They described a variety of expectations from palliative care consultation. Most frequently, they consulted palliative care for specific questions but managed the remainder of the care. Most participants frequently consulted palliative care, but they also worried about fragmentation of care, the timing of when to introduce a new team during MBO, and the selection of appropriate patients for a limited resource. Many participants preferred earlier palliative care consultation, and many described an emotional toll of caring for patients with MBO. Palliative care consultation was most readily discussed for nonsurgical patients. CONCLUSION: Participants’ expectations of palliative care consultations during MBO varied and were not always met. We recommend strengthening communication and protocols for palliative care involvement that meet the needs of specific patient populations and physician teams for surgical and nonsurgical patients. More research is needed to better understand how to integrate palliative care into oncologic and surgical care with gynecologic oncologists.

scholarly journals State of the art in vulvar cancer imaging

2019 ◽  
Vol 52 (5) ◽  
pp. 316-324
Author(s):  
Maria Ana Serrado ◽  
Mariana Horta ◽  
Teresa Margarida Cunha
Keyword(s):  
Computed Tomography ◽  
English Language ◽  
Vulvar Cancer ◽  
Disease Assessment ◽  
Lymph Node Status ◽  
Special Focus ◽  
Vulvar Carcinoma ◽  
Imaging Evaluation ◽  
Surgical Interventions ◽  
Gynecology And Obstetrics

Abstract Vulvar carcinoma is an uncommon tumor that predominantly affects postmenopausal women. Currently, there is no screening procedure for vulvar carcinoma; in most cases, it is diagnosed only when symptoms appear. The most widely used staging system is that developed by the International Federation of Gynecology and Obstetrics. Lymph node status is the most important prognostic factor. We searched the PubMed/Medline database to identify relevant English-language articles on vulvar cancer, with a special focus on its imaging evaluation. Magnetic resonance imaging is useful for local and nodal staging, as well as facilitating the planning of surgical interventions and radiotherapy. Computed tomography or positron-emission tomography/computed tomography can play an important role in nodal and distant disease assessment, whereas ultrasound is often used for image-guided biopsies. Imaging is pivotal for staging and treatment planning in vulvar carcinoma.

Patterns of treatment failure in patients undergoing adjuvant or definitive radiotherapy for vulvar cancer

2019 ◽  
Vol 29 (5) ◽  
pp. 857-862
Author(s):  
Christina Steen Vorbeck ◽  
Anuja Jhingran ◽  
Revathy B Iyer ◽  
Annika Loft ◽  
Ann Klopp ◽  
...  
Keyword(s):  
Adjuvant Radiotherapy ◽  
Clinical Decision Making ◽  
Vulvar Cancer ◽  
Recurrent Disease ◽  
Treatment Strategies ◽  
High Dose ◽  
Definitive Radiotherapy ◽  
Failure Patterns ◽  
Gynecology And Obstetrics ◽  
Dose Planning

ObjectivesKnowledge of the detailed pattern of failure can be useful background knowledge in clinical decision making and potentially drive the development of new treatment strategies by increasing radiotherapy dose prescription to high-risk sub-regions of the target. Here, we analyze patterns of recurrence in patients with vulvar cancer treated with radiotherapy according to original planning target volumes and radiation dose delivered.MethodsWe analyzed dose-planning and post-treatment recurrence scans from patients with vulvar cancer treated at two institutions from January 2009 through October 2014. We delineated the recurrences and merged the dose-planning and recurrence scans for each patient by using deformable co-registration. We estimated the center of each recurrence on the merged scans with the goal of relating them to the original dose plan.ResultsWe evaluated 157 patients who received radiotherapy for vulvar cancer. Median age was 68 years (range 29–91). Patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA-IVB were included. Twenty-nine patients had recurrent disease; 156 patients had squamous cell carcinoma and one patient had adenosquamous carcinoma of the vulva. Among the 157 patients, 37 patients with recurrent disease had recurrence scans available for review, for a total of 80 recurrence sites; 53% of the recurrences were located in the region to which the highest dose (60–70 Gy) had been prescribed. Patients who received definitive radiotherapy developed failure primarily in the high-dose region (80.5%), whereas patients who received adjuvant radiotherapy had a more scattered failure pattern (p<0.0001). Among the latter group, 29.5% failed in the high-dose region.ConclusionsPatients who received definitive versus adjuvant radiotherapy had different failure patterns, indicating that separate approaches are needed to improve both adjuvant and definitive radiotherapy for vulvar cancer.

Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy for the Treatment of Recurrent Endometrial Carcinoma Confined to the Peritoneal Cavity

2010 ◽  
Vol 20 (5) ◽  
pp. 809-814 ◽  
Author(s):  
Naoual Bakrin ◽  
Eddy Cotte ◽  
Anne Sayag-Beaujard ◽  
Daniel Raudrant ◽  
Sylvie Isaac ◽  
...  
Keyword(s):  
Endometrial Carcinoma ◽  
Peritoneal Cavity ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Therapeutic Option ◽  
Performance Status ◽  
Early Recurrence ◽  
Gynecology And Obstetrics ◽  
Initial Surgery

Our objective was to determine if cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a feasible therapeutic option for treatment of peritoneal recurrence of endometrial carcinoma. Between August 2002 and May 2007, 5 patients with recurrent endometrial carcinoma confined to the peritoneal cavity who underwent CRS with HIPEC. Cisplatin (1 mg/kg) and mitomycin C (0.7 mg/kg) were perfused at an inflow temperature of 46 to 48°C for 90 minutes under systemic hypothermia (32°C). Of the 5 patients treated, histopathological type and International Federation of Gynecology and Obstetrics stage were as follows: IB endometrioid (n = 1), IIIA endometrioid (n = 1), IIIC endometrioid (n = 2), and IC endometrioid + pseudosarcomatoid component (n = 1). The mean interval from initial surgery to CRS with HIPEC was 47.5 months (10-120 months). In all patients, CRS was complete. One patient with pseudosarcomatoid component developed recurrent disease 10 months after surgery and died 2 months later. One patient experienced early recurrence with a malignant pleural effusion and died. Three patients are alive and disease free at 7, 23, and 39 months from surgery with good performance status. Regarding the toxicity of the procedure, highly selected patients with recurrent endometrial carcinoma confined to the peritoneal cavity may benefit from improved survival after CRS with HIPEC.

Tumor Residual After Surgical Cytoreduction in Prediction of Clinical Outcome in Stage IV Epithelial Ovarian Cancer: A Gynecologic Oncology Group Study

2008 ◽  
Vol 26 (1) ◽  
pp. 83-89 ◽  
Author(s):  
William E. Winter ◽  
G. Larry Maxwell ◽  
Chunqiao Tian ◽  
Michael J. Sundborg ◽  
G. Scott Rose ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Residual Disease ◽  
Gynecologic Oncology ◽  
Stage Iv ◽  
Gynecologic Oncology Group ◽  
Gynecology And Obstetrics ◽  
Microscopic Residual Disease

Purpose To identify factors predictive of poor prognosis in a similarly treated population of women with stage IV epithelial ovarian cancer (EOC). Patients and Methods A retrospective review of 360 patients with International Federation of Gynecology and Obstetrics stage IV EOC who underwent primary surgery followed by six cycles of intravenous platinum/paclitaxel was performed. A proportional hazards model was used to assess the association of potential prognostic factors with progression-free survival (PFS) and overall survival (OS). Results The median PFS and OS for this group of stage IV ovarian cancer patients was 12 and 29 months, respectively. Multivariate regression analysis revealed that histology, malignant pleural effusion, intraparenchymal liver metastasis, and residual tumor size were significant prognostic variables. Whereas patients with microscopic residual disease had the best outcome, patients with 0.1 to 1.0 cm residual disease and patients with 1.1 to 5.0 cm residual disease had similar PFS and OS. Patients with a residual size more than 5 cm had a diminished PFS and OS when compared with all other groups. Median OS for microscopic, 0.1 to 5.0 cm, and more than 5.0 cm residual disease was 64, 30, and 19 months, respectively. Conclusion Patients with more than 5 cm residual disease have the shortest PFS and OS, whereas patients with 0.1 to 1.0 and 1.1 to 5.0 cm have similar outcome. These findings suggest that ultraradical cytoreductive procedures might be targeted for selected patients in whom microscopic residual disease is achievable. Patients with less than 5.0 cm of disease initially and significant disease and/or comorbidities precluding microscopic cytoreduction may be considered for alternative therapeutic options other than primary cytoreduction.

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