VeraForm®, the only adaptable radiopaque tissue marker, has been deployed to aid radiation treatment planning in thousands of breast cancer patients. Further, as Women’s Health remains at the core of Videra Surgical’s clinical focus, we are delighted to share the success of VeraForm placements in a growing number of GYN oncology procedures in several centers across the U.S.
While about 600,000 hysterectomies are performed every year in the US, approximately 60,000 are cancer-related. Additionally, there are a significant number of other gyn oncological surgeries for metastatic disease. In these cases, surgical approaches vary from laparoscopic, robotic or open and many of these patients can expect to receive radiation therapy following surgery. However, given the dynamic nature of the related anatomy and adjacent critical structures, precise identification of the treatment area can be challenging.
This year, several Gyn oncologists have begun to deploy VeraForm in an effort to aid accurate and efficient radiation treatment planning. A variety of diagnosed cancers have been surgically addressed with both open, robotic and laparoscopic approaches followed by external beam radiation and/or brachytherapy. Gyn oncologists at Mt. Sinai (NY) and Providence/Cedars Sinai Tarzana (CA) have utilized VeraForm during a number of these surgical cases. More recently, surgeons at Adventist Health in Portland (OR) and Peace Health in Vancouver (WA) deployed VeraForm for complex Gyn oncology procedures.
Radiation Oncologists, Scott Schneider M.D. and Nico De Wette M.D. of Compass/U.S. Oncology share a case study here, involving a recent Gynecological cancer patient who received both external beam and brachytherapy treatment. VeraForm was deployed to accurately identify the tumor bed and aid in radiation treatment for this patient.
As part of Videra Surgical’s expanding Women Health initiative, we are proud to collaborate with thought leaders in Gyn Oncology and Radiation Oncology who strive to optimize the standard of care for their cancer patients. We further share in their belief that improving the accuracy and consistency of tumor bed identification may advance radiation therapy treatment as well as significantly improve work flow for the radiation oncologists who perform these critical therapies.
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Case Study
Authors
Dr. Scott B. Schneider
Radiation Oncology
Compass Oncology
Vancouver, Washington
Dr. Nico De Wette
Radiation Oncology
Compass Oncology
Portland, Oregon
69-year-old postmenopausal female who presented to medical attention in September 2019 with postmenopausal bleeding. A pelvic ultrasound on Sept , 2019 revealed a 4.4 x 3.1 x 4.8 cm uterus with a 2.5 mm endometrial stripe. A hysteroscopy, D&C, and polypectomy were performed with pathology revealing EIN and the pathologist could not rule out invasive cancer. The patient was therefore taken to the operating room for robotic assisted laparoscopic hysterectomy and bilateral salpingo-oophorectomy as well as sentinel lymph node biopsy. Pathology revealed grade 1 endometrial adenocarcinoma with 12 of 16 mm depth of invasion (75%) with no lymph vascular space invasion, no cervical involvement, and none of the 3 lymph nodes removed found to be involved. She was therefore staged as having a pT1b N0 M0 adenocarcinoma of the uterus and received no adjuvant therapy.
The patient presented to see Gynecologic Oncologist on Feb 2022 with a history of intermittent vaginal bleeding after urination. A small friable submucosal vaginal nodule was found on exam at 10:00 on the right vaginal sidewall 3 to 4 cm from the introitus. Biopsy was obtained revealing endometrial adenocarcinoma. A PET/CT revealed nonspecific asymmetric right vaginal uptake with SUVs of 3.3 with no lymphadenopathy and no distant metastatic disease. She was seen by radiation oncology consultation in March 2022 for discussion regarding options. The recommendation was made for pelvic radiation to 4500 cGy prior to HDR vaginal brachytherapy. An MRI scan was ordered to define the extent of disease. This revealed a 1.3 cm soft tissue nodule in the right lateral vaginal wall with low-grade enhancement.
The question raised was whether or not this larger than expected distal vaginal recurrence could be resected prior to radiation or should it wait until after radiation prior to HDR. On exam she had a 1.5 cm very distal right-sided lesion with mucosal involvement but deep involvement as well. There is a lot of redundant tissue in this location and it was not close to the urethra so the Gynecologic Oncologist felt that it was going to be a fairly straightforward to remove. She was taken to surgery and a VeraForm marker was used to mark the base of this lesion for localization afterwards. External beam irradiation to 4500 cGy delivered thereafter to the pelvic and inguinal lymph nodes as well as the vaginal and perivaginal tissues followed by HDR.
Given that the patient had a VeraForm marker at the location of her local excision, we could follow dose to the site of local excision and during the brachytherapy boost were able to use a multi-channel cylinder so we could extend the dose to cover the defined CTV.
During vaginal brachytherapy, the VeraForm marker was utilized to accurately locate the tumor bed of the previously resected vaginal tumor and create a Clinical Target Volume (CTV). This helped us determine how deep to push the dose to cover the CT, and by using an multichannel HDR cylinder. It therefore helped customize and accurately deliver HDR brachytherapy to the vagina and bow it out to accurately cover the CTV.
