title: Intraoperative electron beam radiotherapy and extended surgical resection for gynecological pelvic recurrent malignancies with and without external beam radiation therapy: long-term outcomes.
abstract: OBJECTIVE
  To analyze prognostic factors in patients treated with intraoperative electrons containing resective surgical rescue of locally recurrent gynecological cancer (LRGC).
  
  
  METHODS
  From January 1995 to December 2012, 35 patients with LRGC [uterine cervix (57%), endometrial (20%), ovarian (17%), vagina (6%)] underwent extended [multiorgan (54%), bone (9%), soft tissue (54%), vascular (14%)] surgery and intraoperative electron-beam radiation therapy [IOERT (10-15 Gy)] to the pelvic recurrence tumor bed. Sixteen (46%) patients also received external beam radiation therapy [EBRT (30.6-50.4 Gy)]. Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses.
  
  
  RESULTS
  Median follow-up time for the entire cohort of patients was 46 months (range, 3-169). Ten-year rates for locoregional control (LRC) and overall survival (OS) were 58 and 16%, respectively. On multivariate analysis non-EBRT at the time of pelvic re-recurrence [HR 4.15; p = 0.02], no tumor fragmentation [HR 0.13; p=0.05] and time interval from primary tumor to LRR < 24 months [HR 5.16; p=0.01], retained significance with regard to LRR. Non-EBRT at the time of pelvic re-recurrence [HR 4.18; p=0.02] and time interval from primary tumor to LRR < 24 months [HR 6.67; p=0.02] showed a significant association with OS after adjustment for other covariates.
  
  
  CONCLUSIONS
  EBRT treatment integrated for rescue, time interval for relapse ≥ 24 months, and not multi-involved fragmented resection specimens are associated with improved LRC in patients with LRGC in the pelvis. Present results suggest that a significant group of patients may benefit from EBRT treatment integrated with extended surgery and IOERT.
authors.affiliation: Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: F A
authors.initials: FA
authors.lastname: Calvo
authors.forename: C V
authors.initials: CV
authors.lastname: Sole
authors.forename: M A
authors.initials: MA
authors.lastname: Lozano
authors.forename: L
authors.initials: L
authors.lastname: Gonzalez-Bayon
authors.forename: C
authors.initials: C
authors.lastname: Gonzalez-Sansegundo
authors.forename: A
authors.initials: A
authors.lastname: Alvarez
authors.forename: J
authors.initials: J
authors.lastname: Blanco
authors.forename: A
authors.initials: A
authors.lastname: Calín
authors.forename: S
authors.initials: S
authors.lastname: Lizarraga
authors.forename: J L
authors.initials: JL
authors.lastname: García-Sabrido
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D013997:Time Factors
keywords: Extended surgery; External-beam radiation therapy; Intraoperative radiotherapy; Locally recurrent gynecological cancers