Small cell carcinoma of the ovary

Question:

24 yo GOP0 with an 18 cm small cell cancer of the ovary, hypercalcemic type, stage IC. She has undergone surgical staging by a gynecologic oncologist and there are no other findings except for suspicious cytology. Questions: 1) Which chemo? 2) Given the paper by Harrison et al in Gyn Onc in 2006, pelvic RT or whole abdominal RT? 3) when to administer the RT (or sequencing)?

Thanks kindly,
Dave Gaffney

 
Response # 1:  
Dear David,
My only survivor with a similar story of Ic small cell ova I gave whiole abdomen RT with Chrono 5FU ( we were studying the regimen) I would probably use the whole abdomen with FU (but not chrono). Of course the result is an anecdote but I think Tim Russell has one as well with similar treatment.

Gillian Thomas
 

 
Response # 2:
Greetings,

Personally I would  do 4-6 cycles  of cis/carbo etoposide and then  pelvic EBRT and  vag brachy, i do  not think WAR is  justified
I doubt if cis or carbo makes a  difference and carbo kinder
 
Good luck
Nick Reed
 

 
   
Response # 3:  
Dear David,
 
I would first give chemotherapy (and carbo-tax is not a good choice - maybe cis-etoposide) and then give radiotherapy. Although not completely rational, I would give pelvic radiotherapy taking into account the localisation with highest risk (unfortunately, not only risk)
 
Andreas du Bois
 
 
Response # 4:  
Dear Dave,

I have the experience of one patient with a stage IIIc tumor (positive PAO lymph nodes) and normal Cseru calcium. She was send in with the diagnosis germ cell tumor and we started BEP treatment and asked for PA review. At the review the diagnosis small cell cancer of the ovary, hypercalcemic type, stage IIIC. Because she responded to the tumor we continued treatment. At the evaluation after the 4th cycle she still had pathological nodes PAO. She had surgery. At the surgery there was the feeling that the lesions already had increased. The nodes were resected and after resection she had radiotherapy PAO at the location of the lymph nodes. She is still > 5 years tumor free.

Because this is a large tumor but stage ! c with dubious positive cytology I would choose for chemotherapy with BEP or etoposide cisplatin as for small cell tumors. I would  reserve the radiotherapy for localized tumor because you do not know where you should irradiate in this case.

Kind regards,

Maria van der Burg