Intraoperative electron beam radiotherapy and perioperative high-dose-rate brachytherapy in previously irradiated oligorecurrent gynecological cancer: clinical outcome analysis.

Abstract

Pelvic recurrences from previously irradiated gynecological cancer lack solid evidence for recommendation on salvage. A total of 58 patients were included in this clinical analysis. Salvage surgery was performed for locoregional relapse within previously irradiated pelvic area after initial surgery and adjuvant radiotherapy or radical external beam radiotherapy.The primary tumor diagnosis included cervical cancer (n = 47, 81%),uterine cancer (n = 4, 7%), and other types (n = 7, 12%). Thirty-threepatients received adjuvant IOERT(1984-2000)at a median dose of 15Gy(range 10-20Gy) and 25 patients received adjuvant PHDRB(2001-2016)at a mediandose of 32Gy (range 24-40Gy) in 6, 8, or 10b.i.d.fractions. The median follow-up was 5.6years (range 0.5-14.2years). Twenty-nine (50.0%) patients had positive surgical margins. Grade ≥ 3 toxic events were recorded in 34 (58.6%) patients. The local control rate at 2years was 51% and remained stable up to 14years. Disease-free survival rates at 2, 5, and 10years were 17.2, 15.5, and 15.5%, respectively. Overall survival rates at 2, 5, and 10years were 58.1, 17.8, and 17.8%, respectively. IOERT and PHDRB account for an effective salvage inoligorecurrent gynecological tumors. Patients with previous pelvic radiation suitable for salvage surgery and at risk of inadequate margins could benefit from adjuvant reirradiation in form of IOERT or PHDRB. However, the rate of severe grade ≥ 3 toxicity associated with the entire treatment program is relevant and needs to be closely counterbalanced against the expected therapeutic gain.