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Title: Long-Term Survivors Using Intraoperative Radiotherapy for Recurrent Gynecologic Malignancies

Abstract

Purpose: To analyze the outcomes of therapy and identify prognostic factors for patients treated with surgery followed by intraoperative radiotherapy (IORT) for gynecologic malignancies at a single institution. Methods and Materials: We performed a retrospective review of 36 consecutive patients treated with IORT to 44 sites with mean follow-up of 50 months. The primary site was the cervix in 47%, endometrium in 31%, vulva in 14%, vagina in 6%, and fallopian tubes in 3%. Previous RT had failed in 72% of patients, and 89% had recurrent disease. Of 38 IORT sessions, 84% included maximal cytoreductive surgery, including 18% exenterations. The mean age was 52 years (range, 30-74), mean tumor size was 5 cm (range, 0.5-12), previous disease-free interval was 32 months (range, 0-177), and mean IORT dose was 1,152 cGy (range, 600-1,750). RT and systemic therapy after IORT were given to 53% and 24% of the cohort, respectively. The outcomes measured were locoregional control (LRC), distant metastasis-free survival (DMFS), disease-specific survival (DSS), and treatment-related complications. Results: The Kaplan-Meier 5-year LRC, DMFS, and DSS probability for the whole group was 44%, 51%, and 47%, respectively. For cervical cancer patients, the Kaplan-Meier 5-year LRC, DMFS, and DSS estimate was 45%, 60%, andmore » 46%, respectively. The prognostic factors found on multivariate analysis (p {<=} 0.05) were the disease-free interval for LRC, tumor size for DMFS, and cervical primary, previous surgery, and locoregional relapse for DSS. Our cohort had 10 Grade 3-4 complications associated with treatment (surgery and IORT) and a Kaplan-Meier 5-year Grade 3-4 complication-free survival rate of 72%. Conclusions: Survival for pelvic recurrence of gynecologic cancer is poor (range, 0-25%). IORT after surgery seems to confer long-term local control in carefully selected patients.« less

Authors:
 [1];  [2];  [1]; ;  [3]
  1. Department of Radiation Oncology, Stanford Cancer Center, Stanford, CA (United States)
  2. Department of Health Research and Policy, Stanford University Medical Center, Stanford, CA (United States)
  3. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stanford University Medical Center, Stanford, CA (United States)
Publication Date:
OSTI Identifier:
21036254
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 69; Journal Issue: 2; Other Information: DOI: 10.1016/j.ijrobp.2007.03.021; PII: S0360-3016(07)00517-2; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; METASTASES; MULTIVARIATE ANALYSIS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; SURGERY; UTERUS

Citation Formats

Tran, Phuoc T, Zheng, Su, Hara, Wendy, Husain, Amreen, Teng, Nelson, and Kapp, Daniel S. Long-Term Survivors Using Intraoperative Radiotherapy for Recurrent Gynecologic Malignancies. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2007.03.021.
Tran, Phuoc T, Zheng, Su, Hara, Wendy, Husain, Amreen, Teng, Nelson, & Kapp, Daniel S. Long-Term Survivors Using Intraoperative Radiotherapy for Recurrent Gynecologic Malignancies. United States. https://doi.org/10.1016/j.ijrobp.2007.03.021
Tran, Phuoc T, Zheng, Su, Hara, Wendy, Husain, Amreen, Teng, Nelson, and Kapp, Daniel S. 2007. "Long-Term Survivors Using Intraoperative Radiotherapy for Recurrent Gynecologic Malignancies". United States. https://doi.org/10.1016/j.ijrobp.2007.03.021.
@article{osti_21036254,
title = {Long-Term Survivors Using Intraoperative Radiotherapy for Recurrent Gynecologic Malignancies},
author = {Tran, Phuoc T and Zheng, Su and Hara, Wendy and Husain, Amreen and Teng, Nelson and Kapp, Daniel S.},
abstractNote = {Purpose: To analyze the outcomes of therapy and identify prognostic factors for patients treated with surgery followed by intraoperative radiotherapy (IORT) for gynecologic malignancies at a single institution. Methods and Materials: We performed a retrospective review of 36 consecutive patients treated with IORT to 44 sites with mean follow-up of 50 months. The primary site was the cervix in 47%, endometrium in 31%, vulva in 14%, vagina in 6%, and fallopian tubes in 3%. Previous RT had failed in 72% of patients, and 89% had recurrent disease. Of 38 IORT sessions, 84% included maximal cytoreductive surgery, including 18% exenterations. The mean age was 52 years (range, 30-74), mean tumor size was 5 cm (range, 0.5-12), previous disease-free interval was 32 months (range, 0-177), and mean IORT dose was 1,152 cGy (range, 600-1,750). RT and systemic therapy after IORT were given to 53% and 24% of the cohort, respectively. The outcomes measured were locoregional control (LRC), distant metastasis-free survival (DMFS), disease-specific survival (DSS), and treatment-related complications. Results: The Kaplan-Meier 5-year LRC, DMFS, and DSS probability for the whole group was 44%, 51%, and 47%, respectively. For cervical cancer patients, the Kaplan-Meier 5-year LRC, DMFS, and DSS estimate was 45%, 60%, and 46%, respectively. The prognostic factors found on multivariate analysis (p {<=} 0.05) were the disease-free interval for LRC, tumor size for DMFS, and cervical primary, previous surgery, and locoregional relapse for DSS. Our cohort had 10 Grade 3-4 complications associated with treatment (surgery and IORT) and a Kaplan-Meier 5-year Grade 3-4 complication-free survival rate of 72%. Conclusions: Survival for pelvic recurrence of gynecologic cancer is poor (range, 0-25%). IORT after surgery seems to confer long-term local control in carefully selected patients.},
doi = {10.1016/j.ijrobp.2007.03.021},
url = {https://www.osti.gov/biblio/21036254}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 2,
volume = 69,
place = {United States},
year = {Mon Oct 01 00:00:00 EDT 2007},
month = {Mon Oct 01 00:00:00 EDT 2007}
}