How would you proceed for a patient with metastatic gastric-type adenocarcinoma, with vaginal and inguinofemoral disease only, who experiences complete response to her vaginal tumor but residual inguinal disease?

Topics: Radiation Oncology • Gynecologic Cancers • Medical Oncology • NCI-CCC Tumor Board Question • Johns Hopkins • NCI-CCC Gynecologic Tumor Board Question

History of CDH1 mutation and prophylactic gastrectomy in 2017 - no other primary site found beyond vagina at diagnosis.

Vaginal tumor completely responded to FLOT regimen but right inguinal nodes remained enlarged.

Answer from: Radiation Oncologist at Academic Institution

There is no ideal data to guide this. I would recommend surgical nodal excision of the residual inguinal disease, followed by pelvic and inguinal radiation (with or without platinum if the patient can tolerate further). Another approach would be with cisplatin-based chemoradiotherapy with treatment ...

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Radiation Oncologist at Comprehensive Cancer Centers of Nevada
Would maybe consider vaginal HDR boost to consolid...

Answer from: Radiation Oncologist at Community Practice

I have treated these so called isolated vaginal recurrence which is usually supravaginal disease from peritoneal deposit with vaginal extension with definitive RT with EBRT with higher dose to nodes plus brachy (have added concurrent xeloda). I have few patients with long term DFS.

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