2023 ARRS ANNUAL MEETING - ABSTRACTS

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E2603. Interventional Oncology in the Treatment of Metastatic Gynecologic Malignancy
Authors
  1. Kory Dees; University of Alabama at Birmingham
  2. Andrew Gunn; University of Alabama at Birmingham
  3. Michael Straughn; University of Alabama at Birmingham
  4. Theresa Caridi; University of Alabama at Birmingham
Background
Gynecologic malignancies are the third most common group of cancers in women, affecting over 116,000 women each year in the United States. When curative resection is not an option, standard of care has been to combine resection for debulking with chemotherapy and/or radiotherapy to achieve maximum reduction in tumor burden. Early evidence suggests interventional oncology (IO) techniques, such as percutaneous image-guided ablation and intra-arterial targeted therapy, are safe and effective in properly-selected patients. This presentation will provide a review of IO techniques and their use in the management of oligometastatic and metastatic disease of gynecologic cancers.

Educational Goals / Teaching Points
After viewing our presentation, the audience should understand current guidelines and recommendations for the treatment of patients with oligometastatic or metastatic gynecologic malignancies, including uterine cancer, ovarian cancer, and cervical cancer. Additionally, we will review the use of IO techniques, including percutaneous ablation (PA), radioembolization (RE), and chemoembolization (TACE), in the treatment of patients with oligometastatic or metastatic gynecologic malignancies in the literature. We will outline specific patient populations with oligometastatic or metastatic gynecologic malignancies that could benefit from IO therapies, including those eligible for metastasectomy, those with a mixed response to systemic therapy, and those needing a chemotherapy holiday. We will provide case examples from our institution that highlight the nuances of both patient and therapy selection.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Early evidence suggests that IO therapies are both safe and efficacious with lower cost, shorter hospital stays, and fewer complications when compared to surgery. Patients with smaller tumors (<3 cm in size) in the liver, lung, bone, lymph nodes, or soft tissues who are eligible for surgical metastasectomy could be candidates for PA. Patients with solitary tumors in the liver >3 cm who are eligible for surgical metastasectomy could be eligible for RE using a radiation segmentectomy technique. Patients with a mixed response to systemic therapy can have unresponsive tumors in the liver, lung, bone, lymph nodes, or soft tissues that can be targeted with IO therapies rather than moving to another line of chemotherapy. IO techniques can control limited sites of metastatic disease in patients who are not tolerating systemic therapies.

Conclusion
PA, RE, and TACE should be considered as part of a personalized patient care plan in a multidisciplinary setting. There is a growing body of evidence to suggest that IO techniques can be used for patients who are not ideal surgical candidates, those with mixed response to treatment, and those who need a respite from systemic therapy.