9

Doctor,

You were right! The PET/CT scan revealed localized disease right above the vaginal cuff where the scar tissue from surgery is (everyting else is clear). I know that scar tissue is a privileged spot for cancer to grow. The only two times that a CT scan didn't reveal disease in the vaginal cuff area occured when I was on Caelix, and later on Topotecan (when liver metastases showed up). Both Caelix(Doxil) and Topotecan are topoisomerase inhibitors (II and I respectively) and the (probably) rapidly proliferating cancer cells on the scar tissue(vaginal cuff) WERE sensitive to these agents. Here's my questions to you:

1) Since that Avastin works very well on liver metastases and since that Topotecan (which I tolerated much better than Caelix) had made the cancer cells on the scar tissue disappear (or at least kept at bay), shouldn't I try the Avastin + Topotecan combination to get rid of my bowel obstruction?

2) Since that, the disease is localized right above the vaginal cuff where the scar tissue is, why not do braquitherapy in that spot?

[Annekathryn Goodman, M.D.]

Dear vfc

thank you for your follow up. You ask good questions. Without seeing your scans, it is hard for me to really say what is the best solution. Avastin is associated with bowel perforation and in general is not a good choice in the setting of a bowel obstruction. radiation can be a very useful choice but it is really important to make sure the bowel is not in the way or you will develop significant bowel complications from radiation (perforation, obstruction.

please keep me posted