Friday, January 29, 2016



A 60-year-old female with a history of Stage IV ovarian carcinoma presented with rising CA-125 levels (21.1 U/ml to 34.4 U/ml), signifying a probable ovarian carcinoma recurrence. Subsequent MRI showed a 2.8 x 2.5 cm nodule in the region of the left upper vaginal cuff which was confirmed by bimanual examination. Initial diagnosis of Stage IV ovarian carcinoma was made six years earlier when the patient presented with right-sided pleural effusion and CA-125 of 1482 U/ml. An exploratory laparotomy was done and an omental cake, peritoneal studding and a nodule adjacent to the rectosigmoid were resected. Pathology showed poorly differentiated serous papillary ovarian carcinoma.

Over the next four years the patient underwent multiple rounds of chemotherapy as well as stem cell transplant and additional surgical resection in the effort to control her disease. The patient’s latest chemotherapy was prematurely discontinued when she experienced a severe anaphylactoid reaction. At that time the decision was made to follow her closely with imaging and CA-125 measurements.

CyberKnife® Treatment Rationale

 Epithelial ovarian cancer is the leading cause of death among women. More than 70% of women with epithelial ovarian cancer have Stage III or IV disease at the time of diagnosis
1 Adjuvant chemotherapy is recommended for all patients with advanced stage ovarian cancer after appropriate surgery. However, more than 70% of patients relapse, with a median time to progression of less than 2 years.
2 Secondary surgery for recurrent patients has not significantly improved survival. Radiation therapy has improved survival in a subset of patients with chemotherapy-refractory disease, particularly those patients with minimal residual or relapsed disease to the pelvis, and has provided good palliation in patients with local abdominopelvic symptoms.
3 This patient presented with a recurrent ovarian cancer in the left vaginal cuff. Due to the patient’s medical history, she was not a candidate for further chemotherapy or surgery. Nevertheless, the left vaginal cuff recurrence was and had always been the only site of recurrence in this patient, therefore aggressive definitive care was indicated.
The use of stereotactic body radiotherapy as an alternative to brachytherapy for gynecologic tumors has been reported to achieve excellent local control rates with minimal toxicities.

4 offered a minimally invasive method for delivering hypofractionated radiation to the left vaginal cuff of a patient who had failed two surgical resections and numerous cycles of chemotherapy.

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