Limited training exposure in intraoperative radiation therapy (IORT) may result in omission of its use in treating locally advanced gynecologic malignancies

Abstract

CAH and EIN who underwent any type of hysterectomy. Of these patients, 2315 had concurrent bilateral or unilateral oophorectomy (83.2%). Occult ovarian cancer was found in 27 of these cases, representing an overall risk of 1.2%. Stratified by age, 15 of 1838 women b65 years of age and 12 of 477 who were ≥65 years old had ovarian cancer on final pathology, representing an 0.8% and 2.5% risk of ovarian cancer in these age groups, respectively. We determined the relative risk of occult ovarian malignancy at the time of surgical management of CAH to be 3.1 at age ≥65 vs. age b65 years (relative risk 3.08, 95% CI 1.5–6.5, Fisher's exact test P b 0.006). Conclusions: Conventional management of CAH/EIN in women who have completed childbearing does not differ from that of endometrial cancer, including total abdominal hysterectomy/bilateral salpingooophorectomy. This practice is compelled by the theoretical risk of continued hormonal stimulation of residual endometrial disease, the risk of a synchronous ovarian malignancy, and the risk of metastasis to the ovary. Studies endorsing the safety of hormone replacement therapy in endometrial cancer patients argue against the detrimental effect of estrogen in endometrial cancer patients and, therefore, in CAH/ EIN as well. Our study demonstrates a low incidence of ovarian malignancy in women with CAH/EIN, especially in women b65 years of age, providing compelling evidence to support ovarian preservation. As data increase regarding the health benefits of ovarian preservation in postmenopausal women, a paradigm shift in the surgical management of CAH in these same women should follow.