Intraoperative Radiation Therapy in the Management of Gynecologic Malignancies

Foley, Olivia W.; Rauh-Hain, Jose Alejandro; Clark, Rachel M.; Goodman, Annekathryn; Growdon, Whitfield B.; Boruta, David M.; Schorge, John O.; Carmen, Marcela G. del

doi:10.1097/coc.0000000000000063

Cited by 19 publications

(17 citation statements)

References 22 publications

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“…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].…”

Section: Margin Status and Volume Of Residual Diseasementioning

confidence: 80%

“…This included 2 peripheral nerve, 2 gastrointestinal, 2 ureteral injuries in addition to 1 soft tissue and 1 vascular complication. Foley et al noted toxicity directly related to IORT in 5 out of 32 patients: 2 patients with ureteral obstruction, 1 with bone, and 2 with lymphedema complications [45].…”

Section: Side Effects Of Intraoperative Radiationmentioning

confidence: 99%

“…Multiple retrospective studies have demonstrated the importance of negative margins for local control with increased local and distant recurrences as well as decreased overall survival with positive margins [22,45] even if IORT is used. 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].…”

Section: Margin Status and Volume Of Residual Diseasementioning

confidence: 99%

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Intraoperative radiation therapy (IORT) for gynecologic malignancies

Backes

Martin

2015

Gynecologic Oncology

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Section: Margin Status and Volume Of Residual Diseasementioning

confidence: 80%

Section: Side Effects Of Intraoperative Radiationmentioning

confidence: 99%

Section: Margin Status and Volume Of Residual Diseasementioning

confidence: 99%

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Intraoperative radiation therapy (IORT) for gynecologic malignancies

Backes

Martin

2015

Gynecologic Oncology

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“…IORT has shown to improve local control and thus survival in locally recurrent cancers [113–121] of the uterine cervix and endometrium, limited locoregional recurrences from endometrial cancers doing much better than recurrences from cervical cancers [119, 122–124]. The benefit of IORT is seen much more in patients with microscopic residual disease than in those with gross residual disease [113–115, 121]. Patient selection based on resection status and volume of recurrence are the most important factors determining outcome after IORT.…”

Section: Clinical Results With Iortmentioning

confidence: 99%

Intraoperative radiotherapy: review of techniques and results

Pilar¹,

Gupta²,

Laskar³

et al. 2017

ecancer

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Intraoperative radiotherapy (IORT) is a technique that involves precise delivery of a large dose of ionising radiation to the tumour or tumour bed during surgery. Direct visualisation of the tumour bed and ability to space out the normal tissues from the tumour bed allows maximisation of the dose to the tumour while minimising the dose to normal tissues. This results in an improved therapeutic ratio with IORT. Although it was introduced in the 1960s, it has seen a resurgence of popularity with the introduction of self-shielding mobile linear accelerators and low-kV IORT devices, which by eliminating the logistical issues of transport of the patient during surgery for radiotherapy or building a shielded operating room, has enabled its wider use in the community.Electrons, low-kV X-rays and HDR brachytherapy are all different methods of IORT in current clinical use. Each method has its own unique set of advantages and disadvantages, its own set of indications where one may be better suited than the other, and each requires a specific kind of expertise.IORT has demonstrated its efficacy in a wide variety of intra-abdominal tumours, recurrent colorectal cancers, recurrent gynaecological cancers, and soft-tissue tumours. Recently, it has emerged as an attractive treatment option for selected, early-stage breast cancer, owing to the ability to complete the entire course of radiotherapy during surgery. IORT has been used in a multitude of roles across these sites, for dose escalation (retroperitoneal sarcoma), EBRT dose de-escalation (paediatric tumours), as sole radiation modality (early breast cancers) and as a re-irradiation modality (recurrent rectal and gynaecological cancers).This article aims to provide a review of the rationale, techniques, and outcomes for IORT across different sites relevant to current clinical practice.

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“…Other studies have reported on the significance of margin status on worse survival [1,28,29]. Maggioni et al reported on 106 patients undergoing PE and of those patients with cervical and vaginal cancers, 27 had positive margins on final pathology.…”

Section: Discussionmentioning

confidence: 96%