The virtues of treating Virchow.

What do you do for the woman with locally advanced cervical cancer...and the not at all locally involved supraclavicular node? Technically she’s stage IVB, but it’s hard to to give a hard pass on curative treatment for something that is barely metastatic. A retrospective look at 38 women treated at MD Anderson for oligometastatic cervical cancer reports impressive disease control and survival with definitive treatment. Oligometastatic was defined as 1-2 synchronous (n=9) or metachronous (n=29) metastatic sites. All 9 patients with synchronous supraclavicular nodal involvement had that volume included in their standard definitive radiation, while the other recurrent metastatic sites received an array of definitive doses including SBRT. From time of last definitive treatment, median progression free survival was 22 months and overall survival was over 4 years. TBL:Notwithstanding the retrospective selection bias, women with oligometastatic cervical cancer and a good performance status can do well for a long time if all disease is tackled with definitive treatment. | Ning, Gynecol Oncol 2018