The treatment of gynecologic cancers has improved owing to strong multidisciplinary efforts over the years. These efforts have resulted in a sharp reduction in both the incidence and mortality of invasive cervical cancer and marked improvements in early detection of the disease. Now, emphasis is being placed on fertility preservation, and options are being explored in cervical cancer as well as in other cancers where this may be possible. The treatment of vulvar cancer, which can be quite debilitating in its advanced stages, has followed an approach similar to that of breast cancer, where radical surgery has given way to a multimodal approach that emphasizes quality of life as well as survival.

The introduction of paclitaxel was a major development in the primary treatment of ovarian cancer. This monograph also describes the appropriate use of other cytotoxic drugs for the treatment of recurrence or for palliation. As this book goes to press, there is more cogent evidence that intraperitoneal platinum-based therapy is likely to become a part of the standard treatment in this disease. In addition to therapy advances, there have been improvements in diagnostic tools and their application in ovarian cancer.

We would like to acknowledge Walter Pagel, director of the Department of Scientific Publications at MD Anderson Cancer Center, for his role in continuing to make the MD Anderson Cancer Care Series a success. We would also like to thank the volume editors, Drs. David M. Gershenson, Patricia J. Eifel, John J. Kavanagh, and Elvio G. Silva, and the authors of this first monograph on gynecologic cancer for their significant efforts to assemble what we believe will be a most useful and important resource for any physician who diagnoses and treats gynecologic cancer.

Aman U. Buzdar, M.D.
Ralph S. Freedman, M.D., Ph.D.


This book represents the culmination of a process that has evolved over almost 6 decades since Felix Rutledge and Gilbert Fletcher first stepped onto the scene at MD Anderson Cancer Center. Their shared vision of a multidisciplinary approach to caring for gynecologic cancer patients has not only persisted to the present but has, indeed, flourished.

Gynecologic Cancer is the most recent—but not the only—work to detail the practice of gynecologic cancer care at MD Anderson. Proceedings of MD Anderson’s Clinical Conferences on Cancer focused on gynecologic cancer were published in 1962, 1969, and 1987. These books principally outlined the MD Anderson multidisciplinary approach to the clinical
management of gynecologic malignancies. In addition, Dr. Fletcher’s Textbook of Radiotherapy, published in 1980, and a 1976 textbook authored by Dr. Rutledge, J. Taylor Wharton, and Richard Boronow—Gynecologic Oncology—further described treatment techniques and recommendations.

Over the past several years, the face of MD Anderson’s Gynecologic Oncology Multidisciplinary Program has changed markedly. The faculty is much larger in number and considerably more diverse. Although evidence-based medicine is the guiding principle in clinical decision making, a myriad of clinical scenarios exist for which there is no single therapeutic
strategy. In such instances, differing viewpoints are healthy, and the wealth of experience gained from a large-volume practice is a tremendous asset. Also, the value of the peer-review process used in our Multidisciplinary Planning Conference and Clinic cannot be overestimated.

Of course, the treatment recommendations and practice guidelines included in this text are anchored on past clinical trial research and are continually updated as results of new trials become available. Although the clinical trial portfolio of our multidisciplinary group is ever changing and little discussed here, research-driven patient care is of critical importance
in advancing our mission.

Also, we would like to acknowledge and thank Dawn Chalaire, ChaRhonda Chilton, Stephanie Deming, Kim M. Dupree, Manny Gonzales, Vickie J. Williams, and Chris Yeager of the Department of Scientific Publications for editing and compiling this volume.

On behalf of all the contributors to this book, it is a pleasure to present this new work that reflects MD Anderson practice early in this new millennium. And finally, we dedicate this book to all the women with gynecologic cancer who have undergone treatment at MD Anderson over the past 60-plus years.

David M. Gershenson, M.D.
Patricia J. Eifel, M.D.
John J. Kavanagh, M.D.
Elvio G. Silva, M.D.

© 2006 Springer-Verlag New York, Inc. All rights reserved. ISBN 0-387-28794-9.