Oncology Scan – Gynecological Cancers: New Treatments, Old Treatments, Imaging, and Meta-Analyses

This article covers some new and contending debates into treatment of gynae cancers. Nesvacil et al. Adaptive image guided brachytherapy for cervical cancer: A combined MRI-/CT-planning technique with MRI only at first fraction. Radiother Oncol 2012. gold standard magnetic resonance imaging (MRI) for all brachytherapy fractions. image-guided brachytherapy for cervical cancer in 20 patients, comparing plans based on (1) MRI guidance only with (2) MRI guidance for the first insertion and initial 2 fractions and computed tomography (CT) for the subsequent 2 fractions. The data indicate that on evaluation of the total treatment dose comparing the full MRI planning to the MRI/CT planning method, the MRI/CT planning underestimates the real D90 by 1.5 ± 4.3 Gy. full MRI planning technique was compared with the MRI/CT technique with transfer of data back to MRI anatomy for the “real dose” delivered, the mean D90 difference was smaller by 0.7 ± 5.3 Gy. Comparison studies between CT and MRI have demonstrated the superiority of MRI; however, its adoption worldwide has been hindered by the expense and lack of availability of MRI. Kong et al. Adjuvant radiotherapy for stage I endometrial cancer. Cochrane Database Syst Rev 2012- The results of this meta-analysis reconfirm the effectiveness of EBRT in reducing LRR for women with early-stage endometrial cancer but do not find evidence that EBRT improves overall survival. Results on the implement og EBRT depend on how one evaluates the goals of EBRT, i.e. is local regional recur rate a justified end point use to implement EBRT? Thus much debate over treatment for early stage still exists, Frumovitz et al. Anatomic location of PET-positive aortocaval nodes in patients with locally advanced cervical cancer: implications for surgical staging. Int J Gynecol Cancer 2012. 46 patients who underwent pretherapy positron emission tomography (PET)/CT before definitive radiation/chemotherapy for cervical cancer to access pelvic and para-aortic lymph node involvement according to molecular imaging in patients with stage IB-IV disease. = 93% of patients with PET-positive para-aortic lymph nodes also had pelvic lymph node involvement → a stepwise progression along parametrial structures to pelvic (obturator, external iliac, internal iliac), common iliac node echelons and finally along the para-aortic chain. 7% of patients had para-aortic node involvement without pelvic involvement → alternative pathways may be at play through lymphatic spread along ovarian vessels directly to the upper para-aortic chain. Hoskins et al. Low-stage ovarian clear cell carcinoma: Population-based outcomes in British Columbia, Canada, with evidence for a survival benefit as a result of irradiation. J Clin Oncol 2012. role of abdominal and pelvic RT (APRT) for patients with stage I or II clear cell ovarian cancer. All underwent standardized ovarian cancer surgery followed by 3 (APRT cohort) or 6 (no APRT) cycles of platinum/taxane chemotherapy → 22.5 Gy to the entire peritoneal cavity and an additional 22.5 Gy to the pelvis. APRT as consolidative treatment after standard chemotherapy is feasible and safe and may be associated with improved survival in selected patients compared with chemotherapy alone. clear cell cancer is biologically distinct from other types of ovarian cancer and exhibits different clinical behavior. Clear cell tumors are more likely to be confined to the pelvis. This study shows survival advantage in patients with stage IC or II disease and positive peritoneal cytology or ovarian surface involvement Ref http://www.sciencedirect.com/science/article/pii/S0360301613001077