Locally Advanced Primary and Recurrent Gynecologic Malignancies

The Role of Intraoperative Radiation Therapy (IORT) in the Treatment of Locally Advanced Gynecologic Malignancies

“…Local failure may be the primary cause of death in as many as 60% of patients who die from carcinoma of the cervix or endometrium [1]. Only a selected group of women with locally recurrent disease confined to the central pelvis have a chance of cure with exenterative surgery [1].…”

“…Radiation doses required to control gross residual or microscopic disease in the pelvis are in excess of those tolerated by normal surrounding structures [2,3]. Radiation can be safely delivered in doses of 45-54 Gy (in 25-30 fractions of 1.8 Gy) [1]. However, the external beam radiation doses needed to treat residual disease after gross resection would prove to be too morbid [2][3][4].…”

“…For patients with locally advanced gynecologic malignancies, not previously irradiated, preoperative external beam radiation therapy (EBRT) is also recommended [1]. This treatment may be in conjunction with chemotherapy.…”

“…In the case of previous irradiation, full-dose EBRT is not an option. If further treatment via this modality is at all possible, re-treatment depends on the radiation dose previously used, the time interval that has elapsed from treatment to recurrence, and the anatomical location of recurrence in relation to normal structures [1].…”

“…• Surgery alone would not result in acceptable local control [1][2][3][4]. Positive microscopic margins would likely exist if surgery alone was performed [1].…”