PurposeTo define prognostic factors associated with improved survival and local control (LC) for gynecologic cancer recurrences limited to the pelvis and para-aortic (PA) region using stereotactic body radiation therapy (SBRT).MethodsBetween 2/2008 and 7/2014, 30 women (35 targets) with pelvic or PA recurrence of endometrioid (n = 12), cervical (n = 11), ovarian (n = 3), uterine-serous (n = 2), or carcinosarcoma (n = 2) cancer were treated with SBRT. Eleven recurrences were located in the central pelvis, 11 along the pelvic sidewall (PSW), and 13 in the PA region.ResultsFive-year survival for all patients was 42% with a median survival of 43.4 months. Multivariate analysis revealed better performance status (PS), and smaller clinical tumor volume was significant for improved survival (p < 0.05).ConclusionSBRT is a local therapy for recurrent gynecological malignancies in the pelvis and PA region with curative potential. SBRT is especially effective for LC when targeting PSW or PA recurrence and for patients with a cervical/endometrioid uterine primary. Survival is improved for patients with better PS and smaller recurrence volume prior to SBRT.
adjunct to this procedure was placement of an absorbable mesh, which was secured to the abdominal wall and circumferentially to the pelvis, which was to suspend the small bowel away from the brachytherapy region (7 patients). iHDR-BT using a Syed-Nesblett template was performed with an Ir 192 source and computed tomography (CT)-simulation based planning. The age at diagnosis, stage (FIGO 2008), race, operative time and blood loss, catheter number, EBRT and iHDR-BT dose/fraction BED, in terms of equivalent doses at 2 Gy per day (EQD2; a/b ratio of 3 and 10), chemotherapy, urinary and fecal incontinence, and acute radiation toxicity were reviewed. Results: The median follow-up was 13.3 months (1e56.5). All patients completed the prescribed EBRT and brachytherapy radiation. There were no treatment-related deaths. The median age was 60 years (37e66). The 6 primary cervical SCCa patients were stage IIIA (2), IIIB (1), and IVA (3). The mean total operative time was 225 minutes (150e300 min). Intraoperative blood loss varied from <5 to 150 mL. The mean number of catheters was 33 (26e42). The mean EQD2 was 70.1 Gy (65.6e74.4; a/b ratio 10) and 75.7 Gy (71.2e90.3; a/b ratio 3). Platinum-based chemotherapy was given weekly during EBRT. One patient had intermittent fecal incontinence one month after iHDR-BT and was managed conservatively. No bowel or bladder injury had occurred with catheter insertion. Conclusion: Our data shows that robot-assisted placement and visualization of catheters for iHDR-BT boost is a safe and feasible treatment of locally advanced cervical malignancies. Intraoperative visualization of catheter insertion facilitated precise positioning to avoid damage to surrounding structures and allowed optimized placement to the site of disease. The addition of a pelvic sling served to ensure minimal dose and toxicity to the small bowel.
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