Multimodality approach in extra cervical locally advanced cervical cancer: Chemoradiation, surgery and intra-operative radiation therapy. A phase II trial

Intraoperative radiation therapy (IORT) for gynecologic malignancies

“…Three of fifteen deaths were due to septic pelvic complications. As expected, disease outside the cervix after completion of chemoradiation was a poor prognostic factor [39].…”

“…The only prospective, randomized clinical trial of EBRT +/− IORT has been conducted in patients with completely resected retroperitoneal sarcoma. Sindelar et al found that radiation-related neuropathy was more common (9/15 patients) after EBRT (35)(36)(37)(38)(39)(40) plus IORT (20 Gy) versus those who received high dose EBRT (50-55 Gy) only (1/20 patients) [56]. Other complications such as vascular complications are uncommon and this is likely due to the fact that IORT is usually not immediately directed at the vessels.…”

“…Giorda et al conducted a phase II study of patients with locally advanced cervical cancer stage IIA (bulky)-IVA without evidence of extrapelvic disease. Patients received external beam radiotherapy (50.4 Gy) with concurrent cisplatin and 5-fluorouracil (5-FU), but no brachytherapy [39]. Surgery with radical hysterectomy and pelvic lymphadenectomy was performed 6-8 weeks after chemoradiation.…”

The Role of Intraoperative Radiation Therapy in the Management of Recurrent and Locally Advanced Gynecologic Cancers

“…Eight (23%) of the 35 patients had a complete response; 27 of 35 had residual disease either microscopic (17 of 27) or gross (10 of 27). 22 The authors reported a 5-year disease-free survival rate of 46% and an overall survival rate of 49%. 22 Importantly, all recurrences were seen within 24 months from treatment.…”

“…1,3,4,19Y21 In a phase II trial, patients with stage IIA-bulky (94 cm) to stage IVA locally advanced cervical cancer were treated with EBRT and concurrent chemotherapy followed by surgery and IORT. 22 After chemoradiation therapy, 35 (83%) of 42 patients in the study underwent surgery and IORT. Eight (23%) of the 35 patients had a complete response; 27 of 35 had residual disease either microscopic (17 of 27) or gross (10 of 27).…”