title: Pelvic exenteration for cervix cancer: would additional intraoperative interstitial brachytherapy improve survival?
abstract: OBJECTIVE
  Improved local control with the addition of brachytherapy to pelvic exenteration for recurrent cervical cancer has been reported to improve survival. We examined the sites of recurrence after pelvic exenteration to determine if these patients might have been salvaged by the improved local control promised by interstitial brachytherapy. We sought to identify risk factors available intraoperatively or perioperatively which might predict decreased local control.
  
  
  METHODS
  A retrospective review of 26 patients with recurrent cervical cancer who underwent total pelvic exenteration since 1988 at our institution was performed.
  
  
  RESULTS
  Overall, the mean follow-up was 29.5 months (range 6.1-81.6). Of the 26 patients, 14 had no evidence of disease (NED), 1 was alive with disease (AWD), 9 were dead of disease (DOD), and 2 died of unrelated causes (DOC). Seven of 26 patients (27%) had margins < or = 5 mm, of whom 2 were NED, 4 DOD, and 1 AWD. Seven of 26 (27%) patients had lymphovascular involvement (LVI) or perineural invasion (PNI) with clear margins. Three of the seven with LVI or PNI and clear margins were NED, and four DOD. Of the 10 failures, 9 (90%) had close margins, PNI, or LVI.
  
  
  CONCLUSIONS
  Our data reveal that 9 of 14 (64%) patients with close margins, LVI, or PNI were DOD or AWD, and 6 of 9 of those patients suffered local regional failure alone. Brachytherapy has the potential to cure 6 of 14 (43%) patients with these risk factors. Further study of brachytherapy at the time of pelvic extenteration is warranted.
authors.affiliation: Department of Radiation Oncology, Albert Einstein Cancer Center and Montefiore Medical Center, Bronx, NY 10467-2490, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Beitler
authors.forename: P S
authors.initials: PS
authors.lastname: Anderson
authors.forename: S
authors.initials: S
authors.lastname: Wadler
authors.forename: C D
authors.initials: CD
authors.lastname: Runowicz
authors.forename: M K
authors.initials: MK
authors.lastname: Hayes
authors.forename: A L
authors.initials: AL
authors.lastname: Fields
authors.forename: B
authors.initials: B
authors.lastname: Sood
authors.forename: G L
authors.initials: GL
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D010385:Pelvic Exenteration; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*