AAWR Refresher Courses

RSNA 2009

RC616: Imaging and Role of Radiation in Gynecologic Malignancies  Z Liao, MD, Houston, TX Moderator

Dec 03 2009 08:30 AM - 10:00 AM, S403B

Staging Gynecologic Malignancies J R Fielding, MD, Chapel Hill, NC

Role of Imaging in the Treatment of Gynecologic Malignancies with Radiation P J Eifel, MD, Houston, TX

 Imaging Assessment of Treatment Response in Gynecologic Malignancies K J Macura, MD, PhD, Baltimore, MD

ABSTRACT
The outcome of gynecologic (GYN) cancer patients depends on the stage of the disease at the time of diagnosis, and response to the treatment. Imaging plays an important role in pre-treatment staging, in guiding therapy, in evaluating treatment response, and in detecting the site and extent of recurrent and metastatic disease. These topics will be addressed in this 3 part refresher course.

CT, MRI and US can all be used to identify and more often stage GYN malignancies. While the anatomy can be complicated there are key features that require comment for determination of appropriate therapy. The appearance of these features on imaging and recommendation of the test of choice is crucial for accurate staging and decision on appropriate therapy.

Radiation therapy has played critical role in the management of GYN malignancies. CT-based planning has now been considered minimum standard of care for a number of years. Although CT-based planning improved understanding of the spatial relationships between target tissues and critical structures and permitted more accurate estimates of the doses delivered to those structures, the true potential of image guidance in gynecologic radiation therapy planning has only begun to be explored with the increasing availability of modern imaging modalities such as MRI and PET. These studies enhance the ability to precisely focus and tailor conformal radiation therapy to areas at risk with greater sparing of normal tissues. Gathered evidence suggests that image guidance can at least prevent catastrophic errors, may improve communication of techniques between centers and will, with more outcome data, provide important opportunities to further improve the radiation treatments.

Imaging plays an important role in the assessment of response after therapy. PET-CT and MRI have been commonly used in the management of GYN malignancies in assessing response to treatment and in forecasting prognosis.

LEARNING OBJECTIVES

1)      To review the imaging findings of greatest clinical importance when staging gynecologic malignancies.

2)      To understand the potential role of modern imaging methods in the planning of external radiation therapy in patients with gynecologic malignancies. 2) To understand the importance and methods of documenting organ motion during the planning of pelvic radiation therapy. 3) To learn current trends and possibilities for improved brachytherapy with the advent of advanced image-guidance techniques.

3)      To review imaging biomarkers from PET-CT and MRI in the assessment of treatment response, tumor recurrence and restaging in cervical, endometrial, and ovarian malignancies.

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