Ablation of Gynecologic Cancers

The use of ablative therapies in gynecologic malignancies can be divided into direct (surgical or intraoperative) and image-guided tumor ablation. In advanced-stage ovarian and endometrial cancers, the primary treatment is surgery, with the goal of removing all visible tumors. In that setting, direct ablative techniques are extremely useful and have become part of the standard modern surgical tools. The most commonly used techniques (argon beam coagulator, ultrasonic surgical aspirator, plasma surgery) along with the evidence supporting their use will be reviewed. On the other hand, the use of image-guided therapies (radiofrequency ablation, cryotherapy, embolization) in gynecologic cancers is limited and mostly reported in the palliative setting in recurrent disease. Radiofrequency ablation is occasionally used to ablate tumors metastatic to the liver, although there is still no evidence showing a benefit to this practice. Embolization of pelvic vessels is a commonly used modality in the palliative treatment of advanced recurrent pelvic malignancies presenting with genitourinary or gastrointestinal bleeding. Intraoperative ultrasound has been used to assist in the identification of suspicious lymph nodes, in the assessment of myometrial invasion, and in the diagnoses of adnexal masses. Unfortunately, results have been disappointing for the most part, and the use of intraoperative ultrasound remains investigational.