title: The use of intraoperative radiation therapy in radical salvage for recurrent cervical cancer: outcome and toxicity.
abstract: OBJECTIVE
  Our purpose was to evaluate the contribution of intraoperative radiation therapy in the management of recurrent cervical cancer.
  
  
  METHODS
  Twenty-two patients were treated with electron beam intraoperative radiation therapy for recurrent cervical cancers that were confined to the pelvis but were too extensive to be adequately treated by radical surgery alone. All patients underwent extensive surgical dissection for exposure and maximal tumor resection. Doses of intraoperative radiation therapy ranged from 14 to 27.8 Gy (median 22 Gy). Twelve patients received intraoperative radiation therapy to address gross residual disease, and 10 patients were treated for microscopically positive or close surgical margins.
  
  
  RESULTS
  The five-year disease-specific survival and local control rates were 43% and 48%, respectively. There were trends toward better local control and disease-specific survival in patients with microscopic residual disease compared with those with gross residual disease. Seven patients had peripheral neuropathy related to treatment, and four of these cases resolved.
  
  
  CONCLUSIONS
  In carefully selected cases intraoperative radiation therapy contributes to radical salvage of patients with recurrent cervical cancer involving the pelvic wall.
authors.affiliation: Department of Radiation Oncology, University of Washington Medical Center, Seattle 98195, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Stelzer
authors.forename: W J
authors.initials: WJ
authors.lastname: Koh
authors.forename: B E
authors.initials: BE
authors.lastname: Greer
authors.forename: J M
authors.initials: JM
authors.lastname: Cain
authors.forename: H K
authors.initials: HK
authors.lastname: Tamimi
authors.forename: D C
authors.initials: DC
authors.lastname: Figge
authors.forename: B A
authors.initials: BA
authors.lastname: Goff
authors.forename: T W
authors.initials: TW
authors.lastname: Griffin
mesh_terms: D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D009364:Neoplasm Recurrence, Local; D010523:Peripheral Nervous System Diseases / Q000209:etiology; D016879:Salvage Therapy; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*