Does intra-operative radiation at the time of pelvic exenteration improve survival for patients with recurrent, previously irradiated cervical, vaginal, or vulvar cancer?

Backes, Floor J.; Billingsley, Caroline C.; Martin, Douglas D.; Tierney, Brent J.; Eisenhauer, Eric L.; Cohn, David E.; O’Malley, David M.; Salani, Ritu; Copeland, Larry J.; Fowler, Jeffrey M.

doi:10.1016/j.ygyno.2014.07.093

Cited by 25 publications

(15 citation statements)

References 32 publications

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“…Other institutions have adopted the LEER procedure with or without the addition of intraoperative radiotherapy (IORT). For example, Backes et al [29] reported a series of 32 previously irradiated women with a pelvic recurrence from cervical, vaginal, and vulvar cancer. Of these patients, 22 did and 10 did not receive IORT in addition to pelvic exenteration or LEER.…”

Section: Treatment Of Local Pelvic Recurrencementioning

confidence: 99%

State-of-the-Art Treatment and Novel Agents in Local and Distant Recurrences of Cervical Cancer

Tempfer

Beckmann²

2016

Oncol Res Treat

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Depending on the stage at initial presentation, cervical cancer will recur in 25-61% of women. Typical manifestations of recurrent cervical cancer include the central pelvis and the pelvic side walls as well as retroperitoneal lymph node basins in the pelvis and the para-aortic region, and - more rarely - supraclavicular lymph nodes. There are no typical symptoms of recurrent cervical cancer. Women with suspected recurrence after cervical cancer based on gynecological examination or organ-specific symptoms must undergo imaging studies and - if technically feasible - biopsy with histological verification, especially in cases of distant metastases, in order to rule out a second primary. Radiotherapy-naïve women should be treated with salvage radiochemotherapy with curative intention. For women with previous radiotherapy, surgery in the form of hysterectomy, local resection, or pelvic exenteration is the treatment of choice. Pelvic exenteration can lead to cure in selected patients, but at the price of a high rate of complications and significant morbidity and mortality. If complete surgical resection is not feasible or if the woman is not a candidate for surgery, chemotherapy with palliative intent should be offered. Patients with recurrent disease outside the pelvis are candidates for systemic chemotherapy. Several agents have shown to be active in this situation, either in single-agent or combination regimens. Platinum-containing regimens have a superior efficacy over non-platinum regimens and bevacizumab may be added to chemotherapy.

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Section: Treatment Of Local Pelvic Recurrencementioning

confidence: 99%

State-of-the-Art Treatment and Novel Agents in Local and Distant Recurrences of Cervical Cancer

Tempfer

Beckmann²

2016

Oncol Res Treat

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“…Distant recurrences occur in 70-80% of patients with gross residual or positive margins versus 20-30% in patients with negative margins [11,23,45]. One small study examined the use of IORT in patients undergoing pelvic exenteration with or without LEER and with or without IORT [46]. Although the cohort was relatively small, they found that patients who required IORT (given for concern for close or positive margins) had worse survival compared with those without IORT.…”

Section: Margin Status and Volume Of Residual Diseasementioning

confidence: 99%

“…Although the cohort was relatively small, they found that patients who required IORT (given for concern for close or positive margins) had worse survival compared with those without IORT. They speculated that IORT may be able to overcome the negative effect of margin status on local control, but that patients with an indication for IORT have a worse prognosis regardless with a high frequency of distant metastases [46].…”

Section: Margin Status and Volume Of Residual Diseasementioning

confidence: 99%

Intraoperative radiation therapy (IORT) for gynecologic malignancies

Backes

Martin

2015

Gynecologic Oncology

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“…The role of intraoperative radiotherapy (IORT) has been evaluated in several retrospective studies, but with confusing results. Thus, there is no evidence to recommend this treatment routinely [ 17 ] (Level of evidence III; Grade of recommendation C). Patients with non-central recurrence after RT: There are different options depending on the location of the lesions and the performance status of the patient: resection (with or without IORT), chemotherapy or best supportive care (Level of evidence IV; Grade of recommendation C).…”

Section: Locoregional or Metastatic Recurrent Diseasementioning

confidence: 99%

SEOM guidelines for cervical cancer

et al. 2015

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Cervical cancer (CC) is the second most common cancer worldwide, strongly linked to high-risk human papilloma virus infection. Although screening programs have led to a relevant reduction in the incidence and mortality due to CC in developed countries, it is still an important cause of mortality in undeveloped countries. Clinical stage is still the most relevant prognostic factor. In early stages, the primary treatment is surgery or radiotherapy, whereas concomitant chemo-radiotherapy is the conventional approach in locally advanced stages. In the setting of recurrent or metastatic CC, for the first time ever, the combination of chemotherapy plus bevacizumab prolongs the overall survival beyond 12 months. Therefore, this regimen is considered by most of the oncologist a new standard of care for metastatic/recurrent CC.

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Does intra-operative radiation at the time of pelvic exenteration improve survival for patients with recurrent, previously irradiated cervical, vaginal, or vulvar cancer?

Cited by 25 publications

References 32 publications

State-of-the-Art Treatment and Novel Agents in Local and Distant Recurrences of Cervical Cancer

State-of-the-Art Treatment and Novel Agents in Local and Distant Recurrences of Cervical Cancer

Intraoperative radiation therapy (IORT) for gynecologic malignancies

SEOM guidelines for cervical cancer

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