Gynecologic Cancer Therapy Research Articles

Performance of the irregular surface compensator compared with four-field box and intensity modulated radiation therapy for gynecologic cancer

PurposeA retrospective planning study was undertaken to evaluate the dosimetric advantages of the irregular surface compensator (ISC) technique, a forward planning technique with electronic compensation algorithm available on Varian Eclipse treatment planning system. This was extensively compared to the conventional four-field box (4FB) and intensity modulated radiation therapy using 5 fields (IMRT5F) on gynecologic cancer patients. MethodsTwenty-two patients were enrolled. The prescribed dose was 50.4Gy in 28 fractions to the primary target including pelvic lymph nodes. 4FB treatment plans were generated, then fluence of anterior and posterior fields were modified to generate ISC plans. IMRT5F were inversely optimized with equally spaced five coplanar fields. Dose-volume parameters were evaluated for the comparison of three planning techniques. The MU and delivery time were also estimated. ResultsIn terms of target coverage, the conformity and homogeneity index of ISC (1.67 and 1.03, respectively) were superior to those of 4FB (2.43 and 1.06, respectively) but slightly inferior to those of IMRT5F (1.10 and 1.02, respectively). ISC also illustrated an overall improvement in normal organ saving. Compared to 4FB, the mean dose of the rectum was reduced by about 4.0–5.0Gy with ISC and IMRT5F. The volume receiving large doses was reduced for bladder with statistical significance with ISC and more with IMRT5F relative to 4FB. The mean number of MU per fraction were 200.86 (4FB), 446.09 (ISC) and 895.59 (IMRT5F). ConclusionThe ISC technique has the superior target coverage and healthy tissue sparing in comparison with conventional 4FB and comparable normal organ saving compared to IMRT5F. The ISC can be an available option for gynecologic radiotherapy.

Pelvic Insufficiency Fracture After Intensity Modulated Radiation Therapy for Gynecologic Cancer

Pelvic Insufficiency Fracture After Intensity Modulated Radiation Therapy for Gynecologic Cancer

Abstract 3183: Delivery of point-of-care management to patients with gynecologic malignancies using comprehensive genomic profiling

Abstract INTRODUCTION: Gynecologic cancers were estimated to occur in 98,280 women in 2015 in the United States and result in 30,440 deaths (Siegel 2015). The most common forms of gynecologic cancers occur in the ovary and uterine corpus (Siegel, 2015). Various reasons for poor outcome in these cancers include the late stage of the disease at the time of diagnosis and therapy resistance. We sought to elucidate alternate treatment avenues based on the genomic profiles of recalcitrant or rare gynecologic tumors. In the process, we aim to determine both the clinical utility and the feasibility of using comprehensive genomic profiling (CGP) during clinical care to identify clinically relevant tumor genomic alterations for these patients while enabling point-of-care management. METHODS: As part of our ongoing prospective clinical trial, we report on the initial 69 patients with gynecologic cancers that were refractory to standard therapy. CGP was performed by Foundation Medicine, Inc. Genomic mutations and alterations were reviewed by members of an expert, multidisciplinary institutional molecular tumor board (MTB). Consensus recommendations by the MTB were provided to the treating physician on genomically targeted, clinically relevant, FDA-approved, on- and off-label therapies and clinical trials. The outcomes were assessed. RESULTS: Study outcomes were available for 64 patients. On average, patients had 4.97 genomic alterations per tumor (range 1-46), while the time from the testing laboratory report to the formulation of recommendations by the MTB was approximately 3-4 weeks. Targeted treatment options were recommended by the MTB for 93% of patients; 39% of these patients had the MTB-based recommendations implemented by the treating physician. A response or clinical benefit was seen in 56% of the patients receiving MTB-based targeted therapy. CONCLUSION: These data suggest that alternatives to standard therapies for recalcitrant gynecologic cancers can be found though CGP and subsequent analysis from members of an expert, multidisciplinary institutional MTB. The formulation of clinical recommendations by an MTB based on tumor genomic profiling results is a feasible option. Further research is needed to understand how this approach shapes clinical decision making. Citation Format: Lorna Rodriguez-Rodriguez, Kim M. Hirshfield, Veronica Rojas, Siraj Ali, Robert S. DiPaola, Darlene Gibbon, Sara Isani, Aliza Leiser, Gregory M. Riedlinger, Shridar Ganesan. Delivery of point-of-care management to patients with gynecologic malignancies using comprehensive genomic profiling. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3183.

Rational selection of biomarker driven therapies for gynecologic cancers: The more we know, the more we know we don't know

Precision medicine is a rapidly evolving area in the treatment of gynecologic malignancies. Advances in sequencing technology have resulted in an increasing wealth of data regarding the genomic characteristics of ovarian, endometrial, and cervical cancers. These vast new datasets of information have led to novel insights into potential vulnerabilities and therapeutic targets for these cancers. However, unraveling the complex molecular changes within cancer cells to determine how best to attack these targets and to identify effective biomarkers of response remains a significant challenge. In this article, we review the current status of biomarker-driven targeted therapy in gynecologic malignancies.

The Impact of Diabetes on Gynecologic Cancer: Current Status and Future Directions.

Diabetes mellitus has reached epidemic proportions in both the United States and worldwide with most authorities reporting a doubling in the prevalence of diabetes over the last 20-30 years. While this epidemic is closely tied to obesity, diabetes mellitus presents potential clinical challenges over and above that observed with obesity alone. From a women's health care prospective, this rise in diabetes may impact a woman's health across her lifespan. More specifically, diabetes impacts not only pregnancy as well as well as other medical conditions, but increases the risk for the development of various malignancies. From a gynecologic cancer standpoint, diabetes is most closely associated with endometrial adenocarcinomas, although increasing attention is being placed upon diabetes and ovarian cancer. Attention is also being placed on the potential role of metformin and its impact on outcomes in diabetics with cancer, as well as a potential preventative and/or adjunctive therapy for gynecologic cancer.

Abstract 3810: Leptomycin B sensitizes ovarian and endometrial cancer cells to TRAIL-induced apoptosis

Abstract One of our most important line of defense against cancer is the use of chemotherapy. Resistance to these drugs represents, however, a fundamental limitation in our ability to treat tumors, especially in ovarian cancer (OC) as well as in endometrial cancer (EC). Both of these cancers display high mortality rate due to the establishment of chemoresistance. It is thus of utmost importance that we develop new approaches to overcome this problem and restore chemosensitivity in cancer cells. Nuclear transport has been shown to be exceedingly important in cell fate dynamics. CRM1, also known as XPO1, is a nuclear export receptor that recognize leucine-rich domain known as “Nuclear Export Signal”. Indeed, substantial CRM1 enrichment is indicative of highly invasive and resistant tumors and is generally suggestive of lower chance of survival. On the other hand, Par-4, an exceptionally rarely mutated protein capable of inducing cell death only in transformed cells while sparing normal cells, is suggested to be activated upon nuclear localization; it is thus considered a powerful, cancer-specific, inducer of cell death. Recent findings suggest that reinstating the ability of Par-4 to accumulate in the nucleus could re-establish its capacity to induce apoptosis. Our hypothesis was that CRM1 nuclear exclusion of Par-4 could be an acquired resistance mechanism in cancer cells. To explore this hypothesis, we first treated various OC and EC cell types with Leptomycin B to observe whether Par-4 would accumulate to the nucleus; to this end, we performed immunofluorescence as well as subcellular protein fractionations. The obtained results suggested that Par-4 was enriched in the nucleus of cells following Leptomycin B treatments. We then treated multiple OC and EC cell lines with a combination of Leptomycin B, cisplatin and TRAIL recombinant protein to determine if Par-4 enrichment through CRM-1 inhibition could sensitizes tumor cells through either extrinsic or intrinsic death pathways. We then assessed cell death and Par-4 cleavage, an important event in Par-4 induced cell death, using western blot and confirmed the results pertaining to cell death by flow cytometry (Annexin V/PI). The obtained results suggested that the combination of Leptomycin B and TRAIL largely increased cell death and apoptosis when compared to their treatment alone. Taken together, these results suggest that CRM1 control export of various tumor suppressors including Par-4, and this could be a putative mechanism responsible for the establishment of chemoresistance in OC as well as EC. The use of CRM1 inhibitors in combination to chemotherapeutic drug treatments could be an attractive strategy to reverse chemoresistance in the context of gynecological cancer therapy. Citation Format: François Fabi, France-Hélène Joncas, Sophie Parent, Valérie Leblanc, Eric Asselin. Leptomycin B sensitizes ovarian and endometrial cancer cells to TRAIL-induced apoptosis. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3810. doi:10.1158/1538-7445.AM2015-3810

Effect of ArginMax on sexual functioning and quality of life among female cancer survivors: results of the WFU CCOP Research Base Protocol 97106.

Problems with sexual functioning are common following therapy for breast and gynecologic cancers, although there are few effective treatments. To assess the impact of ArginMax, a nutritional supplement comprised of extracts of L-arginine, ginseng, gingko, and damiana, as well as multivitamins and minerals, on sexual functioning and quality of life in female cancer survivors. This was a 12-week, randomized, placebo-controlled trial of eligible patients who were 6 months or more from active treatment and reporting problems with sexual interest, satisfaction, and functioning after therapy. The participants took 3 capsules of Arginmax or placebo twice daily. Outcome measures were the Female Sexual Function Inventory (FSFI) and the Functional Assessment of Cancer Therapy - General (FACT-G). Assessments were done at baseline, 4, 8, and 12 weeks. 186 patients with a median age of 50 years were accrued between May 10, 2007 and March 24, 2010. 76% of the patients were non-Hispanic white. Most had breast or a gynecologic cancer (78% and 12%, respectively). At 12 weeks, there were no differences between the ArginMax group (n = 96) and placebo (n = 92) group in sexual desire, arousal, lubrication, orgasm,satisfaction or pain. However, FACT-G total scores were significantly better for participants who took ArginMax compared with those who took placebo (least squares [LS] means, 87.5 vs 82.9, respectively; P = .009). The Fact-G subscales that were most affected were Physical (25.37 vs. 23.51, P = .001) and Functional Well-Being (22.46 vs. 20.72, P = .007). Toxicities were similar for both groups. Study results are limited by a lack of data on the participants' psychological and physical symptoms and sexual partner variables. ArginMax had no significant impact on sexual functioning, but patient quality of life was significantly better at 12 weeks in participants who received ArginMax.

Laser CO2 treatment for vulvar lymphedema secondary to gynecological cancer therapy: A report of two cases and review of the literature.

Vulvar lymphedema is an uncommon and disabling side-effect of pelvic lymphadenectomy and pelvic radiotherapeutic treatment for invasive genital cancer. Lymphorrhea, a complication of lymphedema, may be extremely distressing for patients due to the requirement to wear sanitary towels and as the pain and loss of elasticity of the vulvar skin and mucosa can cause discomfort during coitus. Surgical treatments of lymphorrhea and vulvar lymphedema secondary to gynecological cancer treatments remain controversial and are not currently considered to be the standard therapy. The present study reports two cases of vulvar lymphedema complicated by vulvar lymphorrhea in females who had undergone treatment for cervical and endometrial cancer, respectively; a review of the literature is also included. In the two present cases, vulvar lymphedemas were refractory to standard treatments, including decongestive therapy, manual lymph drainage, elastic bandaging, low-stretch bandaging, exercises and skin care. Laser CO2 excision and vaporization of the whole skin and mucosal tissue of the vulva was successfully performed to treat the lymphorrhea and improve quality of life. Thus, the present two cases indicated that laser CO2 surgery may present an additional therapy for the treatment of genital lymphedema that is refractory to other treatments.

Extended field intensity modulated radiation therapy for gynecologic cancers: Is the risk of duodenal toxicity high?

PurposeThere have been conflicting reports regarding the incidence of duodenal toxicity in patients receiving intensity modulated radiation therapy (IMRT) with an extended field covering the para-aortic (PA) lymph nodes for gynecologic cancers. We reviewed our experiences and rates of duodenal toxicity in patients treated with extended field IMRT. Methods and materialsPatients with either cervical or endometrial cancer who were treated with IMRT to the PA nodes for involved lymph nodes or for prophylactic intent between 2005 and 2013 were included. For prophylactic intent, the radiation dose to the PA nodes was 45 Gy in 25 fractions. For involved lymph nodes, a boost was delivered to the gross disease with a 0.7-cm expansion, with editing for critical structures. The entire duodenum was retrospectively contoured on all patients from the gastric outlet to the jejunal transition. ResultsWe identified 76 eligible patients with endometrial and cervical cancer. The PA region was treated prophylactically in 46.1% (n = 35) and for involved PA lymph nodes in 53.9% (n = 41). The duodenum was contoured on all patients with a median volume of 83.2 cm3 (range, 21.2-174.9 cm3). The mean volume of duodenum receiving 55 Gy (V55) for those treated prophylactically and for involved PA nodes was 0 cm3 and 0.8 cm3 (range, 0-10.6 cm3), respectively (P = .014). Specifically, no patient had a V55 >15 cm3. The mean V40 was 28.3 cm3 (range, 0-77.3 cm3) and 41.4 (range, 0-90.0 cm3), respectively (P = .016). The mean dose delivered to 2 cm3 of the duodenum was 34.9 Gy (range, 0-52.3 Gy) and 50.1 Gy (range, 31.3 - 58.3 Gy), respectively. Grade 3 acute gastrointestinal toxicity was recorded in 3.9% (n = 3) of patients. ConclusionsIn our experience, the treatment of PA lymph nodes using an IMRT technique is associated with a low duodenal toxicity profile and there has been no high-grade late duodenal toxicity.

Quantifying Vaginal Motion Associated With Daily Endorectal Balloon During Whole Pelvis Radiation Therapy for Gynecologic Cancers

30-60% of patients. Even 1 cm of PTV margin was inadequate in 20-30% of patients. The only beneficial effect of knee and feet support was found to reduce V45 and V50 doses of rectum and bladder. Conclusions: PTV margin of 15 mm in superior-inferior and posterioranterior, and 5 mm in lateral directions for CTV primary were found to be adequate in gynecological cancer patients. A minimum of 7 mm margin should be given to iliac CTV. The striking shifting in presacral CTV was believed to be due to the unforeseen malposition of the hip positions of obese patients. Author Disclosure: M. Gultekin: None. C. Yilmaz: None. G. Eren: None. F. Yildiz: None.

Initial Report of the Clinical Feasibility and Acute Toxicities Associated With Pencil Beam Scanning Whole-Pelvis Proton Therapy for Gynecologic Cancers

Initial Report of the Clinical Feasibility and Acute Toxicities Associated With Pencil Beam Scanning Whole-Pelvis Proton Therapy for Gynecologic Cancers

Radiation Dosimetry of Pelvic Floor and Non-Reproductive Sexual Organs in External Beam Radiation Therapy for Gynecologic Cancers

Sexual dysfunction and pelvic floor disorders are common in gynecologic cancer survivors. With the increasing use of MRI in radiation therapy (RT) treatment planning, small yet critical female pelvic structures that were previously unseen during planning CT scans can now be visualized. In this study, we determined the degree of RT dose delivered to anatomic structures of clinical importance in female sexual dysfunction and pelvic floor disorders by pelvis external beam RT.

Extended Field Intensity Modulated Radiation Therapy for Gynecologic Cancers: Is the Risk of Duodenal Toxicity High?

Extended Field Intensity Modulated Radiation Therapy for Gynecologic Cancers: Is the Risk of Duodenal Toxicity High?

Imaging across the life span: innovations in imaging and therapy for gynecologic cancer.

The focus of this article is radiation therapy for gynecologic cancers, with emphasis on imaging-based treatment planning and delivery. For the various gynecologic cancers, radiation oncologists rely on essential clinical information to triage treatment options, and various imaging studies are performed for treatment planning and radiation therapy delivery. A practical approach is provided to help radiologists tailor their reports for the needs of their radiation oncology and gynecologic oncology colleagues, to optimize multidisciplinary care for patients with gynecologic cancer. Template radiology reports are proposed to address the specific information needs of oncologists at each phase-before, during, and after treatment. Fueled by the rapid progress in engineering and computer sciences during the past 2 decades, remarkable advances have been made in anatomic, functional, and molecular imaging and in radiation treatment planning and delivery in patients with gynecologic cancer. Radiation therapy has evolved from a nontargeted approach to a precisely targeted, highly conformal treatment modality, to further improve treatment outcomes and reduce morbidity. High-quality imaging has become essential for staging of the disease, delineation of tumor extent for treatment planning and delivery, and monitoring therapy response. Anatomic and functional imaging has also been shown to provide prognostic information that allows clinicians to tailor therapy on the basis of personalized patient information. This field is an area of active research, and future clinical trials are warranted to validate preliminary results in the field.

Imaging across the Life Span: Innovations in Imaging and Therapy for Gynecologic Cancer

Imaging across the Life Span: Innovations in Imaging and Therapy for Gynecologic Cancer

ASGO's Third Biennial Meeting, December 12-14, 2013

Following the success of the Asian Society of Gynecologic Oncology (ASGO) 1st Meeting Tokyo in 2009, and 2nd Meeting Seoul in 2011, the 3rd Biennial Meeting was successfully held in the Westin Miyako Hotel, Kyoto, located in a beautiful suburb of Kyoto from 12 to 14 December 2013 (Fig. 1). Total number of registrants was 1,349 from 28 countries including 11 non- Asian countries. A total of 402 abstracts were submitted and it was the largest number ever (Table 1). Fig. 1 A photo of round table discussion for serous ovarian cancer session at Hall B (Mizuho) of the 3rd ASGO meeting, Kyoto, Japan (Speaker, David M. Gershenson, USA; Chairpersons, Uma Devi, India; and Hidetaka Katabuchi, Japan). Table 1 Number of registration and presentations by country The meeting was held under the theme of New Era of Gynecologic Oncology in Asia. The purpose of this meeting was to offer participants the important chance to meet together, exchange the knowledge and experience, and encourage face-to-face discussion for women's healthcare. To reach the goals, comprehensive and attractive scientific programs were prepared. There were 3 plenary sessions, including ASGO opening plenary: welcome from Japan, eradication of cervical cancer from Earth, and treatment of advanced/recurrent ovarian cancer: future perspective. There were 3 symposiums including current status of cervical cancer in Asian countries, molecular targeting therapy, laparoscopic and robotic surgery for gynecologic cancer. Furthermore, there were 5 educational lecture sessions by 20 speakers and 2 round table discussions by 12 speakers, and 10 workshops composed of 79 free oral presentations. Many renowned researchers contributed to these scientific programs as speakers. Lynette Denny (President of International Gynecologic Cancer Society [IGCS], South Africa), Michael Quinn (Australia), and Kailash Narayan (Australia) were from IGCS. Barbara Goff (President of Society of Gynecologic Oncology [SGO], USA), David Gershenson (USA), Steven Silverberg (USA), Paul Magtibay (USA), Anil Sood (USA), Charles Zaloudek (USA), Linus Chuang (USA), Peter Lim (USA), and David Huntsman (Canada) were from SGO. Nicoletta Colombo (Past President of European Society of Gynecologic Oncology [ESGO], Italy), Vesna Kesic (President of ESGO, Serbia), Angelo Maggioni (Italy), and Murat Gultekin (Turkey) were from ESGO. A total of 231 general posters from 16 countries were presented through the meeting (Table 1). At the beginning of meeting, Professor Toshiharu Kamura, President of ASGO, delivered the presidential address, featuring the past, present, and future of ASGO. He stressed that ASGO should play an essential role in understanding, investigating, and resolving regional health problems in cooperation with other sister societies, such as IGCS, SGO, and ESGO (Fig. 2). Fig. 2 A commemorative photo of Sister Societies Meeting which was held during the 3rd ASGO meeting, Kyoto, Japan (from left; Dong Hoon Suh, Korea; Jae-Weon Kim, Korea, Secretary-Treasurer of ASGO; Shingo Fujii, Japan, Past President of IGCS; Joo-Hyun Nam, Korea, ... Another important role of ASGO is encouraging young trainee to acquire the advanced techniques and knowledge to improve their clinical practice and research work. At this meeting, 22 doctors from low income countries received ASGO Travel Grant, and 23 young doctors who submitted outstanding abstracts received Grants for Young Asian Doctors. In addition to the excellent scientific program, Professor Ikuo Konishi, the Congress Chairman, provided memorable social programs. For example, at the general banquet, NST orchestra (composed of JSOG members) played a splendid performance. All participants were impressed with warm hospitality. Congratulations to Professor Kamura, Professor Konishi and all the members of local organizing committee. During the meeting, the 8th ASGO council meeting was held. Many important issues were discussed including a new council member, membership fee, next meeting schedules, and coordinating with other sister societies. At the closing ceremony (Fig. 3), Dr. Kailash Narayan (Australia) and Dr. Takuma Fujii (Japan) won Journal of Gynecologic Oncology Best Reviewer Award 2013. Based on the success of the 3rd Biennial Meeting, ASGO must progress to new era of gynecologic oncology under the new presidency of Professor Joo-Hyun Nam. We will meet again at the 3rd International Workshop 2014 (23-24 August) in Seoul. The 4th Biennial Meeting 2015 will be held in Seoul (12-14 November) by Professor Hee-Sug Ryu, the Congress President. Fig. 3 A commemorative photo of Closing Ceremony of the 3rd ASGO meeting, Kyoto, Japan (from left; Ting-Chang Chang, Taiwan; Jae-Weon Kim, Korea; Yao-Ching Hung, Taiwan; Takuma Fujii, Japan; Toshiharu Kamura, Japan; Marliyya Zayyan, Nigeria; Neerja Bhatla, India; ...

Phytochemicals: a multitargeted approach to gynecologic cancer therapy.

Gynecologic cancers constitute the fourth most common cancer type in women. Treatment outcomes are dictated by a multitude of factors, including stage at diagnosis, tissue type, and overall health of the patient. Current therapeutic options include surgery, radiotherapy, and chemotherapy, although significant unmet medical needs remain in regard to side effects and long-term survival. The efficacy of chemotherapy is influenced by cellular events such as the overexpression of oncogenes and downregulation of tumor suppressors, which together determine apoptotic responses. Phytochemicals are a broad class of natural compounds derived from plants, a number of which exhibit useful bioactive effects toward these pathways. High-throughput screening methods, rational modification, and developments in regulatory policies will accelerate the development of novel therapeutics based on these compounds, which will likely improve overall survival and quality of life for patients.

Clinical and Treatment Factors Associated With Vaginal Stenosis After Definitive Chemoradiation for Anal Cancer

Although VS (vaginal shortening and/or decreased width) is a known long-term toxicity after pelvic radiation therapy (RT) for gynecologic cancer, few studies have evaluated its incidence after definitive chemoRT for anal cancer. We retrospectively reviewed the clinical and treatment characteristics of women treated for anal cancer to identify factors associated with VS. Ninety-six consecutive women who received definitive chemoRT for anal squamous cell carcinoma between 2005 and 2012 comprised the study cohort. NCI CTCAE v. 4 was used to score for VS based on the medical record description of dyspareunia, vaginal dryness or difficult pelvic exam. Other clinical factors examined included age, race, body mass index (BMI), menopausal status, smoking, tumor size/lymph node status (AJCC 7th edition), immunocompromised status, and treatment with abdominoperineal resection (APR). The exact Wilcoxon-Mann-Whitney and Jonckheere Terpstra tests were used to assess VS risk factors. Median age was 60.4 years (range, 19-97). Patient characteristics included: 26% non-White; 14% pre-menopausal; 9% immunocompromised; and 51% with current or prior tobacco use. Stage distribution included 17% T1, 39.5 % T2, 26.5% T3, and 17% T4 tumors; 43% were node positive. Ninety-eight percent received dose-painted IMRT to a median primary tumor dose of 50.4 Gy (range, 41.4 Gy-60 Gy). Chemotherapy included: 83% concurrent mitomycin-C and 5-fluorouracil (5FU), 7% cisplatin and 5FU, 6% 5FU, and 2% capecitabine. APR was performed in 13% for recurrence or late toxicity. With a median follow-up of 2.5 years, 68 women (71%) had some degree of VS and 29% were without sufficient clinical information to assess VS. VS grade distribution was 38% grade 1, 25% grade 2 and 37% grade 3. For women with adequate VS assessment, only younger age (p = 0.016) and higher RT dose (p = 0.05) were predictors of worsening grade of VS on univariate analysis. Seventy-two percent of those with VS reported using measures to prevent it (38% vaginal dilator and 37% intercourse). Women without sufficient information to assess VS had cancers with worse prognostic features, including larger tumors (5 cm vs 3 cm, p < 0.005) and lymph node positivity (63% vs 34%, p = 0.009), had lower median BMI (23 vs 26, p = 0.047), and were more likely to require an APR (25% vs 7.4%, p = 0.04). Vaginal stenosis is a common late complication of radiation therapy in patients treated definitively with chemoradiation for anal cancer, even with IMRT. Younger age and higher prescribed dose are associated with an increased incidence of VS. Measures to prevent stenosis appeared ineffective although compliance may play an important role. We are currently evaluating dosimetric parameters, such as vaginal wall dose, which may contribute to VS.

Volumetric Modulated Arc Therapy Versus 4-Field Box Radiation Therapy for Postoperative Gynecologic Cancer: Are They Covering the Same Planning Target Volume Adequately?

Volumetric Modulated Arc Therapy Versus 4-Field Box Radiation Therapy for Postoperative Gynecologic Cancer: Are They Covering the Same Planning Target Volume Adequately?

Stereotactic body radiation therapy as an emerging ablative therapy for recurrent gynecologic cancer: Early disease and quality of life outcomes from a phase II trial

Stereotactic body radiation therapy as an emerging ablative therapy for recurrent gynecologic cancer: Early disease and quality of life outcomes from a phase II trial