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

Abstract

The prognosis in women with locally advanced primary or recurrent gynecologic malignancies is rather poor. Doses of external beam radiation necessary to treat gross or microscopic recurrence among patients surgically treated or previously irradiated exceed what is tolerated by normal structures. In this group of patients, intraoperative radiation therapy (IORT) can be utilized to maximize local tumor control, minimizing the radiation exposure of dose-limiting surrounding structures. Review of the available literature indicates that IORT may improve long-term local control and overall survival in women with pelvic sidewall and/or para-aortic nodal recurrence. The most encouraging results have been reported in the cases of microscopic residual disease, following surgical debulking. The

Ultraschallgestützte interstitielle Brachytherapie in der Behandlung fortgeschrittener vaginaler Rezidive von Zervix- und Korpuskarzinomen

“…Accepting mutilating consequences, selected patients with central recurrences can be treated by pelvic exenteration with a 50% chance of survival and local control [5,18]. However, for the majority of patients with either infiltration to the pelvic side wall or multifocal disease no promising surgical treatment has been available so far even if special techniques like, e.g., lateral extended endopelvic resection (LEER), combined operative and radiotherapeutic treatment (CORT), and intraoperative radiotherapy after surgical debulkment (IORT) have been developed [6,17,18,34].…”

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

“…IORT was given to the pelvic sidewall (one or both) and once also to the sacral hollow, wherever the suspicion and/or documentation of a close margin was the highest. The median IORT dose was 17.5 Gy (range 10-17.5) in the LEER/IORT group versus 15 Gy (range [15][16][17][18][19][20] in the PE/IORT group (P = 0.7). Beveled cones were used for 11 patients and catheters in 8 patients, while 2 patients received both electron cone IORT and HDR IORT.…”

“…Intraoperative radiation therapy (IORT) may provide adjuvant treatment that potentially can improve survival in the appropriately selected patient [16][17][18][19][20]. IORT is a unique modality that allows the sterilization of microscopic disease.…”

“…In HDR brachytherapy, catheters within a 1 cm thick tissue equivalent material are placed along the tumor bed and a high dose Iridium 192 source is used to deliver the localized radiation. There is data to support that the application of IORT in patients undergoing surgery for recurrent gynecologic malignancies may result in improved long term local control and overall survival [14,[16][17][18][19][20][22][23][24][25][26][27].…”

Intraoperative Radiation Therapy in the Management of Gynecologic Malignancies

“…Patients were candidates for IORT if they could not tolerate high doses of EBRT or doses required for local control would be in excess of 60 to 70 Gy, had localized tumor beds that could be directly targeted by the IORT beam without injury to normal structures, and surgery alone would not provide acceptable local control and addition of IORT to other treatment modalities resulted in potentially curative treatment. 11 Patients were excluded if they were medically infirmed and not surgical candidates, or if there was evidence of distant metastasis.…”