Gyne (new threads)

Extended Field Radiotherapy for Locally Advanced Cervical Cancer

Mon, 18 Apr 2011 17:58:04 +0000

Wanted to know what does the house think about this question.
In the chemoRT era is it standard to offer Extended Field (Para-aortic) RT for Locally Advanced Cervical Cancer ? How many of you routinely prophylactically treat para-aortic LN in absence of para-aortic LN on imaging (CT/MRI/PET) ?

http://www.ncbi.nlm.nih.gov/pubmed/11704321
http://www.ncbi.nlm.nih.gov/pubmed/19010522 (study closed)
http://www.ncbi.nlm.nih.gov/pubmed/19398095

26 yrs, low grade serous Adenoca of ovary

Wed, 13 Apr 2011 19:39:39 +0000

Dear all, interesting case
26 yrs young lady,
Jan 2009: Presented with Ascites: was found to have ovarian tumor(9cms): Surgery- oophorectomy, uterus left behind in situ (patient wants her own baby). Path: Serous Borderline Tumor. Ca-125 =88 prior to surgery.
Nov 2010: Abdominal recurrence on imaging:Complex cystic and solid masses located within the pelvis overall (combined) size of all of these lesions is approximately 7.3 x 6.7 x 9.0 cm (sag x TV x AP), anterosuperior to the urinary bladder with a single one identified within the subcutaneous fat of the anterior lower abdomen. There is also an isolated lesion seen within the right adnexa. The enhancing/vascular nodular components make these consistent with tumour recurrence.
Feb 2011: Interventionist did a guided biopsy: Recurrent Serous Borderline Tumor.
March 2011, de-bulking surgery: Path: Low Grade Serous Adenocarcinoma.

Chemo Vs RT? Role of Chemo in low grade serous adenoca ? If RT, how do we do that, ? Whole Abdomen (patient has uterus in situ and wants her own baby, has tried IVF with 3 futile attempts in 2009-2010).

What is the treatment of choice here ?

Brachytherapy in Retroverted Uterus

Sat, 19 Mar 2011 07:35:27 +0000

All of us have faced problems during IC brachytherapy for Ca Cervix in patients with retroverted uterus.
There are some reports about benefit of US guidance during placement (London Regional cancer Centre, Nina Mayr et al).

Would like to know about personal experiences of members on this

Also it will be great if somebody can mail me full text of following paper

Brachytherapy management of the retroverted uterus using ultrasound-guided implant applicator placement

Nina A. Mayr12Corresponding Author Informationemail address, Joseph F. Montebello12, Joel I. Sorosky3, Jamie S. Daugherty4, Dan L. Nguyen4, George Mardirossian4, Jian Z. Wang4, Susan M. Edwards4, Wenbin Li4, William T.C. Yuh2
Brachytherapy
Volume 4, Issue 1, Pages 24-29 (2005)

Uterine Leiomyosarcoma

Fri, 18 Mar 2011 12:30:05 +0000

52/F
TAH & BSo for vaginal bleeding done
pT: 6*7*9 cm
High Gr leiomyosarcoma

I have searched lit.
Lack of clear evidence for adjuvant therapy.
However some suggetion that RT may reduce rate of pelvic rec. While systemic relapse rates are also reported hence phase2 data supporting use of adjuvant CT is also available.
Comments of the house please
If RT is to be given what should be the volume of radiation

Comparison of two very common fractionation schedules for HDR Gyn brachytherapy

Wed, 23 Feb 2011 04:08:50 +0000

One of the most recent comparison of two common but different fractionation schedules practiced for intracavitory HDR gynecological brachytherapy.
http://www.ncbi.nlm.nih.gov/pubmed/20685179

T1No Vaginal Ca

Sat, 19 Feb 2011 18:38:05 +0000

DIAGNOSIS: Well-differentiated squamous cell carcinoma of the vagina, T1 N0.
55/F , First seen in the Colposcopy Clinic with abnormal cytology from the vaginal vault.
The vaginal vault was noted to have a whitened epithelium, particularly towards the apical region.
Bx: VIN 3 from the 12 o’clock position and from the vaginal apex. Also at the 3 o’clock position but additionally, several foci of small, well-differentiated invasive squamous cell carcinoma were seen all with a depth of less than 1 mm and a focal lymphovascular space invasion. Tumor was noted to extend to the base of the biopsy.
P/H: Testing for HPV done in 2005 which was positive. Was monitored with regular colposcopy.
TAH/BSo 2008 for dysplasia noted in the cervix. No invasive ca on path.
NO H/O STD (sexually transmitted diseases).

Another major problem: Significant Interstitial cystitis of unknown etiology. She was at the point where she was considering a cystectomy but a trial of MacroBID antibiotic has been very helpful in reducing her symptoms.
Now nocturia x2 but prior to MacroBID it was 8 times.
Local Exam: No inguinal femoral LNpathy. Inspection of the external genitalia unremarkable. On speculum exam no visible discreet lesions. On palpation there are no abnormal areas of thickening to suggest obvious disease.

IMPRESSION: 55/F old woman with biopsy proven squamous cell carcinoma of the vagina that is well differentiated with known prior HPV infection and prior dysplasia in the cervix with underlying interstitial cystitis of unknown etiology.

I saw this lady for treatment? Given the focal lympho vascular invasion should I worry out lymph nodes (para vaginal atleast)?

CTV guidelines for Cervix, Postop Cervix , Endometrium

Sun, 23 Jan 2011 07:04:12 +0000

Valuable Resources :

CTV contouring guidelines for post-op Cervix , Endometrium IMRT

Int J Radiat Oncol Biol Phys. 2008 June 1; 71(2): 428–434. doi:10.1016/j.ijrobp.2007.09.042.

CTV contouring guidelines for IMRT Cervix

Int. J. Radiation Oncology Biol. Phys., Vol. 79, No. 2, pp. 348–355, 2011

PET vs USPIO MRI for lymph node staging in cancer cervix

Mon, 17 Jan 2011 08:01:10 +0000

plenty of literature favouring both approaches :

http://www.ncbi.nlm.nih.gov/pubmed/18771811

http://www.ncbi.nlm.nih.gov/pubmed/19792965

http://www.scribd.com/full/46996310?access_key=key-1vz285e1aqipo48homh2 ( MRI vs PET , not USPIO)

both are aggressively advocated , sensitivity and specificity cannot be compared objectively across different patient databases

members' comments and any head on comparisons please

Male circumcision and HPV transmission

Fri, 07 Jan 2011 14:36:55 +0000

Interesting paper http://www.lancet.com/journals/lancet/article/PIIS0140-6736(10)61967-8/fulltext

Reccurence in treated case of endometrial adenocarcinima

Sun, 05 Dec 2010 05:30:18 +0000

56 year old post TAH endometrial adenoca treated in 2008 with PORT. had a brain mets in jan 2010 detected in PET CT ,Palliative RT to brain given with salvage CT pacli+carbo 6 cycle. Now in nov 2010 PET CT shows lung mets on left side single localized.Patient;s GC fair , KPS 90. No co morbidity , treated case of TB fallopian tube 20 years back . What should be the urther management ? can we give localized palliative RT to Lung .?

IMRT for Cervical Cancer

Tue, 30 Nov 2010 02:51:38 +0000

How many of you are using IMRT for Cervical cancer routinely? What contouring guidelines are you following for Cervical Cancer patients?

ICON 7

Tue, 30 Nov 2010 02:49:57 +0000

Does anyone use Avastin in Ovarian Cancer as First line ? What are your thoughts about ICON 7 which was presented in ASCO 2010 and IGCS meetings?

Vaginal Ca with Scleroderma

Wed, 13 Oct 2010 14:54:34 +0000

Hello,
I have a lady who has a primary vaginal cancer. We saw her for RT consult. However she has scleroderma. Does anyone have any experience with RT in the scleroderma and do these patient tolerate RT ?
Thanks
Nikhilesh

Ovarian Cancer

Sun, 01 Aug 2010 05:42:09 +0000

Dear all,
With recent advancements in high precision radiation delivery, there has been some interest in visiting Whole Abdomen Radiotherapy (WAR) for Ovarian malignancies.
Ref: http://www.ncbi.nlm.nih.gov/pubmed/19628341
http://www.ncbi.nlm.nih.gov/pubmed/18330510
http://www.ncbi.nlm.nih.gov/pubmed/18188517
http://www.ncbi.nlm.nih.gov/pubmed/19918228
there are many more articles in pubmed mainly from the German group, wanted to know what does our group think about WAR ?
Nikhilesh

Cervical cancer Vaccine

Fri, 28 May 2010 12:54:28 +0000

Cervical cancer vaccine, i would like to each individual opinion and the argument, for and against.

I do not recommend it for i think that the data does not satisfy me.
The simplest way for me to put it is as follows,

If you eat salt, you have to drink water, if you drink water , you quench thirst.
So salt quenches thirst. This is borrowed from Michael de Montaigne.

It is not that prudent to implement or think of Vaccination when screening is not uniformly introduced.

CTRT Cervix Cochrane Meta-analysis

Tue, 02 Mar 2010 05:14:44 +0000

http://www.ncbi.nlm.nih.gov/pubmed/20091664?dopt=Abstract
http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD008285/pdf_fs.html

Carinoma Vulva

Mon, 22 Feb 2010 04:13:14 +0000

92 yrs elderly lady, KPS 70/80 %,diagnosed of carcinoma vulva 1983 which was treated surgically, had several recurrence which were all salvaged surgically. Most recent surgery April 2009 (4.7 cms x 3cms tumor, depth 1.9cms Sq.ca ) had wound healing issues till Nov-Dec 2009. Now has local recurrence on left vulva clinically 5cm x 3cms, max depth 2cms which is painful, discharge and minimal oozing, repeat biopsy VIN III, B/L pedal odema due to her prior GND. Co-morbidities DM,HT,IHD all controlled. Several allergies—-including erythromycin,penicillin,domperidone, codeine,docusate sodium, phytoin and many other drugs. No lymph node palpable. CT scans normal except the primary area which is not very clearly visualized.

How would you treat this lady, options ?