Introduction/Background Advanced/recurrent gynecologic cancer is a clinical challenge. The ideal treatment was controversial and how to manage recurrent condition was also an unsolved problem. We present four advanced cervical/endometrial cancer cases who were heavily treated before and they achieved complete remission after curative intent including immune checkpoint inhibitors (ICIs).
Methodology We retrospectively reviewed clinical records of these four such patients.
Results Case 1: A 51-year-old nulliparous woman was diagnosed with cervical adenocarcinoma, International Federation of Gynecology and Obstetrics (FIGO) stage IVB, treated by concurrent chemoradiation and maintenance bevacizumab. Bone metastasis treated with radiotherapy focus on metastasis sacrum lesion and pembrolizumab combined with 5-FU and etoposide chemotherapy sequentially. She remains disease free with overall survival (OS) 35.3+ months.
Case 2: A 34-year-old woman had cervical adenocarcinoma, FIGO stage IVA, treated by chemoirradiation. Central pelvic recurrence at 8 years was treated by total pelvic exenteration with intra-operative radiotherapy (IORT) for involved pelvic side wall margin, and salvage chemotherapy. Re-recurrence at para-aortic lymph node (PALN) found later. She achieved remission with pembrolizumab and radiotherapy.
Case 3: A 42-year-old woman had cervical squamous cell carcinoma, FIGO IIIC and recurrence once that she received operation and chemoirradiation in China. Second relapse at left para-spinal and paraureter soft tissue noted. Pembrolizumab, cisplatin and topotecan with radiotherapy was applied. She is currently disease free (OS 134+ months).
Case 4: A 39-year-old woman had endometrial carcinoma, FIGO stage IIIC1. She received primary operation and chemo-radiotherapy. First recurrence at left pelvic lymph node was treated by operation, intra-operative brachytherapy and chemotherapy. 2nd relapse at left PALN was salvaged by proton therapy to PALN, chemotherapy, and pembrolizumab. No disease detected till now (OS 77+ months).
Conclusion Incorporating ICIs to proton therapy and chemotherapy provide long disease-free survival to advanced/recurrent gynecologic cancer failed traditional chemoirradiation.
Disclosure Nothing to disclose.
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