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01.02.2014 | Original article

External-beam radiation therapy after surgical resection and intraoperative electron-beam radiation therapy for oligorecurrent gynecological cancer

Long-term outcome

verfasst von: C.V. Sole, M.D., F.A. Calvo, M.D., Ph.D., M.A. Lozano, M.D., L. Gonzalez-Bayon, M.D., Ph.D., C. Gonzalez-Sansegundo, M.D., A. Alvarez, M.D., S. Lizarraga, M.D., J.L. García-Sabrido, M.D., Ph.D.

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 2/2014

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Abstract

Purpose

The goal of the present study was to analyze prognostic factors in patients treated with external-beam radiation therapy (EBRT), surgical resection and intraoperative electron-beam radiotherapy (IOERT) for oligorecurrent gynecological cancer (ORGC).

Patients and methods

From January 1995 to December 2012, 61 patients with ORGC [uterine cervix (52 %), endometrial (30 %), ovarian (15 %), vagina (3 %)] underwent IOERT (12.5 Gy, range 10–15 Gy), and surgical resection to the pelvic (57 %) and paraaortic (43 %) recurrence tumor bed. In addition, 29 patients (48 %) also received EBRT (range 30.6–50.4 Gy). Survival outcomes were estimated using the Kaplan–Meier method, and risk factors were identified by univariate and multivariate analyses.

Results

Median follow-up time for the entire cohort of patients was 42 months (range 2–169 months). The 10-year rates for overall survival (OS) and locoregional control (LRC) were 17 and 65 %, respectively. On multivariate analysis, no tumor fragmentation (HR 0.22; p = 0.03), time interval from primary tumor diagnosis to locoregional recurrence (LRR) < 24 months (HR 4.02; p = 0.02) and no EBRT at the time of pelvic recurrence (HR 3.95; p = 0.02) retained significance with regard to LRR. Time interval from primary tumor to LRR < 24 months (HR 2.32; p = 0.02) and no EBRT at the time of pelvic recurrence (HR 3.77; p = 0.04) showed a significant association with OS after adjustment for other covariates.

Conclusion

External-beam radiation therapy at the time of pelvic recurrence, time interval for relapse ≥ 24 months and not multi-involved fragmented resection specimens are associated with improved LRC in patients with ORGC. As suggested from the present analysis a significant group of ORGC patients could potentially benefit from multimodality rescue treatment.

Weichselbaum RR, Hellman S (2011) Oligometastases revisited. Nat Rev Clin Oncol 8:378–382PubMed

Hockel M, Dornhofer N (2006) Pelvic exenteration for gynaecological tumours: achievements and unanswered questions. Lancet Oncol 7:837–847PubMedCrossRef

Perez CA, Kuske RR, Camel HM et al (1988) Analysis of pelvic tumor control and impact on survival in carcinoma of the uterine cervix treated with radiation therapy alone. Int J Radiat Oncol Biol Phys 14:613–621PubMedCrossRef

Garton GR, Gunderson LL, Webb MJ et al (1997) Intraoperative radiation therapy in gynecologic cancer: update of the experience at a single institution. Int J Radiat Oncol Biol Phys 37:839–843PubMedCrossRef

Gemignani ML, Alektiar KM, Leitao M et al (2001) Radical surgical resection and high-dose intraoperative radiation therapy (HDRIORT) in patients with recurrent gynecologic cancers. Int J Radiat Oncol Biol Phys 50:687–694PubMedCrossRef

Stelzer KJ, Koh WJ, Greer BE et al (1995) The use of intraoperative radiation therapy in radical salvage for recurrent cervical cancer: outcome and toxicity. Am J Obstet Gynecol 172:1881–1888PubMedCrossRef

Martínez-Monge R, Jurado M, Aristu JJ et al (2001) Intraoperative electron beam radiotherapy during radical surgery for locally advanced and recurrent cervical cancer. Gynecol Oncol 82:538–543PubMedCrossRef

Carmen MG del, Eisner B, Willet CG et al (2003) Intraoperative radiation therapy in the management of gynecologic and genitourinary malignancies. Surg Oncol Clin N Am 12:1031–1042PubMedCrossRef

Mahe MA, Gerard JP, Dubois JB et al (1996) Intraoperative radiation therapy in recurrent carcinoma of the uterine cervix: report of the French intraoperative group on 70 patients. Int J Radiat Oncol Biol Phys 34:21–26PubMedCrossRef

10.

Tran PT, Su Z, Hara W et al (2007) Long-term survivors using intraoperative radiotherapy for recurrent gynecologic malignancies. Int J Radiat Oncol Biol Phys 69:504–511PubMedCrossRef

11.

Barney BM, Petersen IA, Dowdy SC et al (2012) Long-term outcomes with intraoperative radiotherapy as a component of treatment for locally advanced or recurrent uterine sarcoma. Int J Radiat Oncol Biol Phys 83:191–197PubMedCrossRef

12.

Dowdy SC, Mariani A, Cliby WA et al (2006) Radical pelvic resection and intraoperative radiation therapy for recurrent endometrial cancer: technique and analysis of outcomes. Gynecol Oncol 101:280–286PubMedCrossRef

13.

Haddock MG, Martinez-Monge R, Petersen IA, Wilson TO (2011) Locally advanced primary and recurrent gynecological malignancies: EBRT with or without IOERT or HDR-IORT. In: Gunderson LL, Willett CG, Calvo FA, Harrison LB (eds) Intraoperative irradiation. Techniques and results, 2nd edn. Springer, New York

14.

Pascau J, Santos Miranda JA, Calvo FA et al (2012) An innovative tool for intraoperative electron beam radiotherapy simulation and planning: description and initial evaluation by radiation oncologists. Int J Radiat Oncol Biol Phys 83:287–295

15.

Clavien PA, Barkun J, Oliveira ML de et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196PubMedCrossRef

16.

Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the Radiation Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341–1346PubMedCrossRef

17.

Azinovic I, Calvo FA, Puebla F et al (2001) Long-term normal tissue effects of intraoperative electron radiation therapy (IOERT): late sequelae, tumor recurrence, and second malignancies. Int J Radiat Oncol Biol Phys 49:597–604PubMedCrossRef

18.

Aubey JJ, McCreath W, Chi DS, Alektiar K et al (2004) Outcomes of patients with recurrent gynecological malignancues treated with with radical surgical resection and high-dose rate intraoperative radiotherapy (HDR-IORT). The 35th Annual SGO meeting in San Diego, CA

19.

Barney BM, Petersen IA, Dowdy SC et al (2013) Intraoperative Electron Beam Radiation Therapy (IOERT) in the management of locally advanced or recurrent cervical cancer. Radiat Oncol 8:80 (Epub ahead of print)PubMedCentralPubMedCrossRef

20.

Singh AK, Grigsby PW, Rader JS et al (2005) Cervix carcinoma, concurrent chemoradiotherapy, and salvage of isolated paraaortic lymph node recurrence. Int J Radiat Oncol Biol Phys 61:450–455PubMedCrossRef

21.

Brocker KA, Alt CD, Eichbaum M et al (2011) Imaging of female pelvic malignancies regarding MRI, CT, and PET/CT: part 1. Strahlenther Onkol 187:611–618PubMedCrossRef

22.

Alt CD, Brocker KA, Eichbaum M et al (2011) Imaging of female pelvic malignancies regarding MRI, CT, and PET/CT: part 2. Strahlenther Onkol 187:705–714PubMedCrossRef

Titel: External-beam radiation therapy after surgical resection and intraoperative electron-beam radiation therapy for oligorecurrent gynecological cancer
Long-term outcome
verfasst von: C.V. Sole, M.D.
F.A. Calvo, M.D., Ph.D.
M.A. Lozano, M.D.
L. Gonzalez-Bayon, M.D., Ph.D.
C. Gonzalez-Sansegundo, M.D.
A. Alvarez, M.D.
S. Lizarraga, M.D.
J.L. García-Sabrido, M.D., Ph.D.
Publikationsdatum: 01.02.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 2/2014
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-013-0472-5

Springer Medizin

External-beam radiation therapy after surgical resection and intraoperative electron-beam radiation therapy for oligorecurrent gynecological cancer

Long-term outcome