title: Radical pelvic resection and intraoperative radiation therapy for recurrent endometrial cancer: technique and analysis of outcomes.
abstract: OBJECTIVE
  To describe the technique and assess outcomes and morbidity following radical resection combined with intraoperative electron radiation therapy (IOERT) in patients with recurrent endometrial cancer.
  
  
  METHODS
  From 1986 to 2002, 25 patients received treatment including radical resection and IOERT for recurrent endometrioid, endometrial cancer. Relevant clinical information was extracted through retrospective chart review.
  
  
  RESULTS
  Treatment prior to referral included radiation in 56% and either a secondary surgery or chemotherapy in 48%. External radiation (EBRT) was administered in addition to IOERT in 84%. Radical procedures performed at the time of IOERT included resection of the pelvic sidewall en bloc with the obturator nerve, external iliac vein, psoas, iliacus, or obturator internus muscles, ureter, or boney ileum. Seven patients required exenteration in combination with resection of the pelvic sidewall. The median IOERT dose was 1500 cGy (range 1000-2500 cGy). Overall five-year survival was 47% vs. 71% for those with a gross total resection but close margins. Two patients with recurrences limited to the para-aortic area are alive without evidence of disease at 54 and 71 months. Proportional hazards modeling showed concurrent EBRT, tumor size after resection, grade, and age to be associated with improved survival. The most common complications were peripheral neuropathy, functional ureteral obstruction, and fistula formation.
  
  
  CONCLUSIONS
  With an aggressive treatment approach including radical resection combined with IOERT, long-term survival is possible in a significant number of patients with localized recurrent endometrial cancer. Preoperative radiation paired with complete surgical resection utilizing extended procedures is paramount to achieving optimal outcomes.
authors.affiliation: Division of Gynecologic Surgery, 200 1st St. NW, Rochester, MN 55905, USA. dowdy.sean@mayo.edu
authors.forename: Sean C
authors.initials: SC
authors.lastname: Dowdy
authors.forename: Andrea
authors.initials: A
authors.lastname: Mariani
authors.forename: William A
authors.initials: WA
authors.lastname: Cliby
authors.forename: Michael G
authors.initials: MG
authors.lastname: Haddock
authors.forename: Ivy A
authors.initials: IA
authors.lastname: Petersen
authors.forename: Franklin H
authors.initials: FH
authors.lastname: Sim
authors.forename: Karl C
authors.initials: KC
authors.lastname: Podratz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D004583:Electrons / Q000627:therapeutic use*; D016889:Endometrial Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome