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Long-Term Survivors Using Intraoperative Radiotherapy for Recurrent Gynecologic Malignancies
International Journal of Radiation Oncology*Biology*Physics, Volume 69, Issue 2, 1 October 2007, Pages 504-511

Abstract: PurposeTo analyze the outcomes of therapy and identify prognostic factors for patients treated with surgery followed by intraoperative radiotherapy (IORT) for gynecologic malignancies at a single institution.Methods and MaterialsWe performed a retrospective review of 36 consecutive patients treated with IORT to 44 sites with mean follow-up of 50 months. The primary site was the cervix in 47%, endometrium in 31%, vulva in 14%, vagina in 6%, and fallopian tubes in 3%. Previous RT had failed in 72% of patients, and 89% had recurrent disease. Of 38 IORT sessions, 84% included maximal cytoreductive surgery, including 18% exenterations. The mean age was 52 years (range, 30–74), mean tumor size was 5 cm (range, 0.5–12), previous disease-free interval was 32 months (range, 0–177), and mean IORT dose was 1,152 cGy (range, 600–1,750). RT and systemic therapy after IORT were given to 53% and 24% of the cohort, respectively. The outcomes measured were locoregional control (LRC), distant metastasis-free survival (DMFS), disease-specific survival (DSS), and treatment-related complications.ResultsThe Kaplan-Meier 5-year LRC, DMFS, and DSS probability for the whole group was 44%, 51%, and 47%, respectively. For cervical cancer patients, the Kaplan-Meier 5-year LRC, DMFS, and DSS estimate was 45%, 60%, and 46%, respectively. The prognostic factors found on multivariate analysis (p ≤ 0.05) were the disease-free interval for LRC, tumor size for DMFS, and cervical primary, previous surgery, and locoregional relapse for DSS. Our cohort had 10 Grade 3-4 complications associated with treatment (surgery and IORT) and a Kaplan-Meier 5-year Grade 3-4 complication-free survival rate of 72%.ConclusionsSurvival for pelvic recurrence of gynecologic cancer is poor (range, 0–25%). IORT after surgery seems to confer long-term local control in carefully selected patients.

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