Gynecologic Cancer (Radiation Medicine Rounds, Volume 2, Issue 3)

Radiation Medicine Rounds is a trinary, hard cover, periodical designed to provide an up-to-date review of a dedicated radiation medicine topic of interest to clinicians andscientists who are involved in the care of patients receiving radiotherapy. It is intended to serve as both a reference and instructional tool for students, housestaff, fellows, practicing clinicians, medical physicists, cancer biologists, radiobiologists, and interdisciplinary colleagues throughout the oncology spectrum. With contributions from experts across the U.S., Gynecologic Cancer details the current management of different types of gynecologic cancer. Today the management of gynecologic cancers is multidisciplinary in nature, requiring close collaboration between gynecologic oncologists, medical oncologists, and radiation oncologists. Gynecologic Cancer reviews new therapies in use and under development for gynecologic cancer including novel radiation approaches, the role of chemotherapy and novel biologic agents, new and emerging surgical approaches, and the role of MRI in assessing tumor response in cervical cancer patients. It is a valuable tool for clinicians, nurses, researchers, medical students, residents, and fellows. Included in Gynecologic Cancer Intensity-Modulated Radiotherapy for Gynecologic Malignancies In-Room Image-Guided Radiation Therapy for Cervical Cancers Image-Guided Brachytherapy in Cervical Cancer Intensity-Modulated Radiotherapy in Vulvar Cancer Chemotherapy in Advanced/Recurrent Endometrial Cancer Biologic Agents and Immune Therapy in Gynecologic Cancers Lymphadenectomy in Uterine Cancer Robotic Surgery in Gynecologic Cancer Magnetic Resonance Imaging for Assessing Tumor Response in Cervical Cancer " Cover Halftitle Editorial Board Title Copyright Contents Foreword Preface Contributors Intensity-Modulated Radiotherapy for Gynecologic Malignancies ABSTRACT INTRODUCTION PELVIC RT Dosimetric Studies Treatment Planning and Delivery Toxicity and Outcomes EXTENDED-FIELD RT Dosimetric Studies Treatment Planning and Delivery Toxicity and Outcomes PELVIC-INGUINAL RT Dosimetric Studies, Treatment Planning,and Delivery Toxicity and Outcomes WHOLE-ABDOMINAL RT Dosimetric Studies Treatment Planning and Delivery Toxicity and Outcomes NOVEL IMRT APPLICATIONS Bone-Marrow-Sparing IMRT IMRT as an Alternative to Brachytherapy Simultaneous Integrated Boost Stereotactic Body RT NTER- AND INTRAFRACTION MOTION CONCLUSION AND FUTURE DIRECTIONS REFERENCES In-Room Image-Guided Radiation Therapy for Cervical Cancers ABSTRACT INTRODUCTION IMAGE-GUIDED CTV TARGET DELINEATION FOR EXTERNAL BEAM RADIATION THERAPY Postoperative Cervix Intact Cervix IMAGE-GUIDED PTV MARGINS FOR EXTERNAL BEAM RADIATION THERAPY Postoperative Cervix Intact Cervix IMAGE-GUIDED TARGET DELINEATION FOR BRACHYTHERAPY IMAGE-GUIDED TREATMENT DELIVERY CLINICAL APPLICATIONS OF IN-ROOM IGRT TECHNOLOGIES FUTURE DIRECTIONS CONCLUSIONS REFERENCES Image-Guided Brachytherapy in Cervical Cancer ABSTRACT INTRODUCTION ROLE OF IMAGE-GUIDED BRACHYTHERAPY VERSUS ANEBRT BOOST DOSE RATE AND GENERAL RADIOBIOLOGIC PRINCIPLES IMAGING MODALITIES USED IN IMAGE-GUIDED BRACHYTHERAPY Ultrasound Computed Tomography Magnetic Resonance Imaging Positron Emission Tomography Contouring and Dosimetric Nomenclature Timing and Recommended Doses CLINICAL OUTCOMES Applicator: Tandem and Ring/Tandem and Ovoid/Mould Toxicities Applicator: Template-Based Interstitial CONCLUSION REFERENCES Intensity-Modulated Radiotherapy in Vulvar Cancer ABSTRACT INTRODUCTION CLINICAL ASSESSMENT IMMOBILIZATION AND TREATMENT PLANNING CONTOURS Target Volumes OAR IMRT Planning and Dose Selection Image-Guided Radiotherapy DOSIMETRIC STUDIES CLINICAL IMPLEMENTATION Adjuvant RT Locally Advanced Disease CONCLUSIONS REFERENCES Chemotherapy in Advanced/Recurrent Endometrial Cancer ABSTRACT INTRODUCTION ADJUVANT THERAPY: ADVANCED DISEASE HORMONAL THERAPY IN ADVANCED/RECURRENT ENDOMETRIAL CANCER: NO PRIOR CHEMOTHERAPY HEMOTHERAPY IN ADVANCED/RECURRENT ENDOMETRIAL CANCER Single-Agent Studies: No Prior Chemotherapy Phase II Studies Phase III Studies DEVELOPMENTAL THERAPEUTICS IN ADVANCED/RECURRENT ENDOMETRIAL CANCER REFERENCES Biologic Agents and Immune Therapy in Gynecologic Cancers ABSTRACT INTRODUCTION ANTIANGIOGENIC AGENTS Bevacizumab Afl ibercept Sunitinib Pazopanib Brivanib Other TKI EGFR INHIBITORS Monoclonal Antibody Inhibitors to EGFR Small Molecule Inhibitors Multitargeted TKIs INHIBITORS OF THE PI3-KINASE/AKT/MTOR PATHWAY Akt Phosphotidylinositol-3-kinase (PI3K) mTOR (Protein Mammalian Target of Rapamycin) Endometrial Cancer and PTEN Temsirolimus, Deforolimus, and Everolimus OTHER AGENTS Aurora Kinase Inhibitors PARP Inhibitors Hedgehog Inhibitors IMMUNOTHERAPY Monoclonal Antibody Therapy Adoptive Immunothera Tumor Vaccine Therapy SUMMARY REFERENCES Lymphadenectomy in Uterine Cancer ABSTRACT INTRODUCTION IMPORTANCE OF AND ALTERNATIVES TO LYMPHADENECTOMY Importance of Stage Preoperative Imaging and Biopsy Intraoperative Evaluation Uterine Factors as a Surrogate to Predict Nodal Disease THE CONTROVERSY Nodal Dissection—None Nodal Dissection—Selective Nodal Dissection—Routine Extent of Nodal Dissection LYMPHADENECTOMY TECHNIQUE Surgical Technique Minimally Invasive Management COMPLICATIONS ASSOCIATED WITH LYMPHADENECTOMY REFERENCES Robotic Surgery in Gynecologic Cancer ABSTRACT INTRODUCTION ADOPTION OF ROBOTIC SURGERY TRAINING CLINICAL IMPACT: ENDOMETRIUM CLINICAL IMPACT: CERVIX CLINICAL IMPACT: OVARY COST FUTURE REFERENCES Magnetic Resonance Imaging for Assessing Tumor Response in Cervical Cancer ABSTRACT INTRODUCTION ANATOMICAL TUMOR VOLUME ASSESSMENT BY MRI Tumor Volume, Volume Response Assessment, and Early Outcome Prediction 3D MR Volumetry for Response Assessment and Outcome Prediction FUNCTIONAL MRI ASSESSMENT OF CERVICAL CANCER DCE MRI: Rationale and Methodology DCE Methods FUNCTIONAL MRI–BASED EARLY OUTCOME PREDICTION Serial DCE during Therapy and Temporal Shift of DCE Combination of Tumor Volume and Functional Parameters for Early Outcome Prediction Heterogeneity Assessment of DCE COMBINATION OF DCE WITH OTHER MRI AND CLINICAL RESPONSE PREDICTORS DIFFUSION WEIGHTED IMAGING MRI CONCLUSIONS AND FUTURE DIRECTION REFERENCES Index Back Cover Intensity-modulated radiotherapy for gynecologic malignancies / Lindsay G. Jensen, Arno J. Mundt, and Loren K. Mell In-room image-guided radiation therapy for cervical cancers / Loren K. Mell, Arno J. Mundt and Lindsay Jensen Image-guided brachytherapy in cervical cancer / Akila N. Viswanathan Intensity-modulated radiotherapy in vulvar cancer / David A. Clump and Sushil Beriwal Chemotherapy in advanced/recurrent endometrial cancer / Vicky Makker Biologic agents and immune therapy in gynecologic cancers / Madeleine Courtney-Brooks and Linda Duska Lymphadenectomy in uterine cancer / Elizabeth Kathleen Nugent and Donald Scott McMeekin Robotic surgery in gynecologic cancer / Marilyn Huang and Pedro Ramirez Magnetic resonance imaging for assessing tumor response in cervical cancer / Nina A. Mayr ... [et al.]. A compilation of reviews on recent clinical advances and key clinical research related to the use of radiation medicine in the treatment of gynecologic cancer. It includes articles that review the knowledge in the areas of biologic agents, Intensity Modulated Radiation Therapy, Image-Guided Brachytherapy, and robotic surgery in gynecologic cancer.