title: The use of intraoperative electron beam radiation therapy in the treatment of para-aortic metastases from gynecologic tumors: a pilot study.
abstract: The abdomens of 16 patients with para-aortic nodal metastases were explored in the Clement O. Miniger Radiation Oncology Center's (COMROC) intraoperative radiation therapy suite. At the time of initial diagnosis 8 patients were found to have para-aortic metastases, and 8 developed para-aortic disease after completion of primary treatment. The median age of patients in the "initial group" was 37.5 years: 7 of these 8 patients had radiation only, and 1 patient had radiation and chemotherapy as initial treatment. Bulk disease in the para-aortic region was noted in 2 patients, microscopic disease in 5 patients, and prophylactic radiation was given to the para-aortic area in 1 patient. Ten para-aortic fields in 8 patients were treated with a median dose of 20 (range 10-25) Gy with 6-18 MeV electrons. Median survival from time of diagnosis was 31 (range 9-59) months and 27 (range 8-56) months from the date of IOEBRT. The median time to recurrence after IOEBRT was 8 (range 4-32) months. One patient is alive without disease 59 months and 1 is alive with disease 44 months from IOEBRT, with neither patient failing in the treated area. Eight patients were treated for recurrent disease in the para-aortic area: 5 cervical primaries, 2 endometrial adenocarcinoma primaries, and 1 uterine sarcoma. The median age was 60.5 (range 45-70) years. Median time to recurrence from initial diagnosis was 20 (range 7-37) months. In seven fields 6 of 8 patients received IOEBRT, median dose 20 (range 10-25) Gy. After IOEBRT, 4 of 6 patients received 45 Gy external beam irradiation. Median survival from IOEBRT was 9 (range 3-23) months, 37.5 (range 11-56) months from diagnosis. One patient is alive without disease at 11 months and one is alive with disease 19 months after IOEBRT. Toxicity of the IOEBRT is discussed.
authors.affiliation: Department of Radiation Therapy, Medical College of Ohio, Toledo.
authors.forename: A
authors.initials: A
authors.lastname: Konski
authors.forename: J
authors.initials: J
authors.lastname: Neisler
authors.forename: G
authors.initials: G
authors.lastname: Phibbs
authors.forename: D
authors.initials: D
authors.lastname: Bronn
authors.forename: R R
authors.initials: RR
authors.lastname: Dobelbower
mesh_terms: D000005:Abdomen; D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D015182:Lymphatic Irradiation; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010865:Pilot Projects; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy; D016019:Survival Analysis