External-beam radiation therapy after surgical resection and intraoperative electron-beam radiation therapy for oligorecurrent gynecological cancer

Abstract

External-beam radiation therapy at the time of pelvic recurrence, time interval for relapse ≥ 24 months and not multi-involved fragmented resection specimens are associated with improved LRC in patients with ORGC. As suggested from the present analysis a significant group of ORGC patients could potentially benefit from multimodality rescue treatment.

Intraoperative radiation therapy (IORT) for gynecologic malignancies

“…The role of reirradiation for recurrent epithelial carcinomas is expanding in recent years as more reports are demonstrating the ability to salvage a subpopulation of patients with acceptable toxicity. For recurrent pelvic malignancies without evidence of systemic disease, the decision to add reirradiation to the salvage regimen should be considered [9][10][11]. The volume of reirradiation is most often limited to the region of gross disease with a margin to encompass areas felt to be at high risk for microscopic involvement.…”

“…Importantly, there was no increased toxicity in patients who received EBRT/ surgery/IORT versus those who received surgery and IORT only. Sole described 61 patients who underwent resection for recurrent endometrial (n = 18), cervical (n = 32), ovarian (n = 9) and vaginal (n = 2) cancer [11]. Thirty-five patients had a pelvic and 26 a paraaortic recurrence.…”

“…They found that time from diagnosis to initial recurrence b24 months, squamous cell histology, and not receiving EBRT for recurrence were associated with decreased locoregional control. Short interval from diagnosis to recurrence (b24 months) and not receiving EBRT at the time of recurrence were also associated with worse disease free and overall survival [11]. Although IORT provides a high local dose in a single delivery, higher doses using combined EBRT and IORT appear to be needed for locoregional control of recurrent disease.…”

“…Although IORT provides a high local dose in a single delivery, higher doses using combined EBRT and IORT appear to be needed for locoregional control of recurrent disease. Multimodality therapy appears to have the best outcomes with acceptable toxicities [11]. Most of the studies described in this review involve a combination of radical surgery and intraoperative radiation for patients who have previously received radiation therapy.…”

“…In contrast, others have found no difference in locoregional control for R0 or R1 resections in the setting of IORT, however, all studies' reports demonstrate increased recurrence with R2 resections [11]. 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].…”