title: Perioperative high-dose-rate brachytherapy in locally advanced and recurrent gynecologic cancer: Initial results of a phase II trial.
abstract: BACKGROUND
  This study was undertaken to determine the feasibility of perioperative high-dose-rate brachytherapy (PHDRB) as an adjunct to salvage surgery in primary advanced or recurrent gynecologic cancer.
  
  
  METHODS
  Twenty-five patients with either locally advanced (n = 4) or recurrent (n = 21) gynecologic cancer suitable for salvage surgery were included. Unirradiated patients were treated with preoperative chemoradiation followed by salvage surgery and PHDRB (R0 and R1 resections receiving 16 or 24 Gy, respectively). Previously irradiated patients were treated with salvage surgery and PHDRB alone with 32 or 40 Gy for R0 or R1 resections, respectively.
  
  
  RESULTS
  Resections were categorized as R0 in 9 patients (36.0%) and R1 in 16 (64.0%). Four previously irradiated patients suffered fatal pelvic bleeding between 8 and 13 months after surgery and PHDRB. After a median follow-up of 20 months (3-55+), the 4-year actuarial local and pelvic controls were 88.1% and 80.8%, respectively. The 4-year distant metastases-free survival was 40.9%. Four-year actuarial overall survival was 34.0%, with a median survival of 27.1 months (95% confidence interval: 17.5-36.8).
  
  
  CONCLUSIONS
  Local and pelvic control results are excellent for this very high-risk-disease population. PHDRB dose in previously irradiated patients has been shifted to the closest lower level due to unacceptable vascular toxicity.
authors.affiliation: Department of Oncology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Navarra, Spain. rmartinezm@unav.es
authors.forename: Rafael
authors.initials: R
authors.lastname: Martínez-Monge
authors.forename: Matías
authors.initials: M
authors.lastname: Jurado
authors.forename: Mauricio
authors.initials: M
authors.lastname: Cambeiro
authors.forename: Jeanette
authors.initials: J
authors.lastname: Valero
authors.forename: Elena
authors.initials: E
authors.lastname: Villafranca
authors.forename: Juan L
authors.initials: JL
authors.lastname: Alcázar
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019990:Perioperative Care; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome