title: Radical surgical resection and high-dose intraoperative radiation therapy (HDR-IORT) in patients with recurrent gynecologic cancers.
abstract: OBJECTIVE
  To determine the outcome for patients with recurrent gynecologic tumors treated with radical resection and combined high-dose intraoperative radiation therapy (HDR-IORT).
  
  
  METHODS
  Between November 1993 and June 1998, 17 patients with recurrent gynecologic malignancies underwent radical surgical resection and high-dose-rate brachytherapy. The mean age of the study group was 49 years (range 28-72 years). The site of the primary tumor was the cervix in 9 (53%) patients, the uterus in 7 (41%) patients, and the vagina in 1 (6%) patient. The treatment for the primary disease was surgery with or without adjuvant radiation in 14 (82%) patients and definitive radiation in 3 (18%) patients. The current surgery consisted of exenterative surgery in 10 (59%) patients and tumor resection in 7 (41%) patients. Complete gross resection was achieved in 13 (76%) patients. The mean HDR-IORT dose was 14 Gy (range 12-15). Additional radiation in the form of permanent Iodine-125 implant was given to 3 of 4 patients with gross residual disease. The median peripheral dose was 140 Gy.
  
  
  RESULTS
  With a median follow-up of 20 months (range 3-65 months), the 3-year actuarial local control (LC) rate was 67%. In patients with complete gross resection, the 3-year LC rate was 83%, compared to 25% in patients with gross residual disease, p < 0.01. The 3-year distant metastasis disease-free and overall survival rates were 54% and 54%, respectively. The complications were as follows: gastrointestinal obstruction, 4 (24%); wound complications, 4 (24%); abscesses, 3 (18%); peripheral neuropathy, 3 (18%); rectovaginal fistula, 2 (12%); and ureteral obstruction, 2 (12%).
  
  
  CONCLUSIONS
  Radical surgical resection and combined IORT for patients with recurrent gynecologic tumors seems to provide a reasonable local-control rate in patients who have failed prior surgery and/or definitive radiation. Patient selection is very important, however, as only those patients with complete gross resection at completion of surgery appear to benefit most from this radical approach in the salvage setting.
authors.affiliation: Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. gemgnam@mskcc.org
authors.forename: M L
authors.initials: ML
authors.lastname: Gemignani
authors.forename: K M
authors.initials: KM
authors.lastname: Alektiar
authors.forename: M
authors.initials: M
authors.lastname: Leitao
authors.forename: B
authors.initials: B
authors.lastname: Mychalczak
authors.forename: D
authors.initials: D
authors.lastname: Chi
authors.forename: E
authors.initials: E
authors.lastname: Venkatraman
authors.forename: R R
authors.initials: RR
authors.lastname: Barakat
authors.forename: J P
authors.initials: JP
authors.lastname: Curtin
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy; D003131:Combined Modality Therapy; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy* / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D007430:Intraoperative Care; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery*; D011878:Radiotherapy / Q000009:adverse effects; D016879:Salvage Therapy