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Intraoperative electron beam radiotherapy and perioperative high-dose-rate brachytherapy in previously irradiated oligorecurrent gynecological cancer: clinical outcome analysis

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Abstract

Background

Pelvic recurrences from previously irradiated gynecological cancer lack solid evidence for recommendation on salvage.

Methods

A total of 58 patients were included in this clinical analysis. Salvage surgery was performed for locoregional relapse within previously irradiated pelvic area after initial surgery and adjuvant radiotherapy or radical external beam radiotherapy. The primary tumor diagnosis included cervical cancer (n = 47, 81%), uterine cancer (n = 4, 7%), and other types (n = 7, 12%). Thirty-three patients received adjuvant IOERT (1984–2000) at a median dose of 15 Gy (range 10–20 Gy) and 25 patients received adjuvant PHDRB (2001–2016) at a median dose of 32 Gy (range 24–40 Gy) in 6, 8, or 10 b.i.d. fractions.

Results

The median follow-up was 5.6 years (range 0.5–14.2 years). Twenty-nine (50.0%) patients had positive surgical margins. Grade ≥ 3 toxic events were recorded in 34 (58.6%) patients. The local control rate at 2 years was 51% and remained stable up to 14 years. Disease-free survival rates at 2, 5, and 10 years were 17.2, 15.5, and 15.5%, respectively. Overall survival rates at 2, 5, and 10 years were 58.1, 17.8, and 17.8%, respectively.

Conclusions

IOERT and PHDRB account for an effective salvage in oligorecurrent gynecological tumors. Patients with previous pelvic radiation suitable for salvage surgery and at risk of inadequate margins could benefit from adjuvant reirradiation in form of IOERT or PHDRB. However, the rate of severe grade ≥ 3 toxicity associated with the entire treatment program is relevant and needs to be closely counterbalanced against the expected therapeutic gain.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Oncology, Clínica Universitaria de Navarra, University of Navarra, Avda Pío XII s/n, Pamplona, Navarre, Spain

    P. A. Jablonska, M. Cambeiro, M. Gimeno, J. M. Aramendía, J. J. Aristu, F. A. Calvo & R. Martínez-Monge

  2. Department of Gynecology and Obstaetrics, Clínica Universitaria de Navarra, University of Navarra, Avda Pío XII s/n, Pamplona, Navarre, Spain

    J. A. Mínguez & J. L. Alcázar

Authors
  1. P. A. Jablonska
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  2. M. Cambeiro
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  3. M. Gimeno
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  4. J. M. Aramendía
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  5. J. A. Mínguez
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  6. J. L. Alcázar
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  7. J. J. Aristu
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  8. F. A. Calvo
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  9. R. Martínez-Monge
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Corresponding author

Correspondence to R. Martínez-Monge.

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The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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This study was conducted according to the principles outlined in the Declaration of Helsinki and was approved by the Institutional Review Board.

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All patients provided a written informed consent to the treatment.

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Jablonska, P.A., Cambeiro, M., Gimeno, M. et al. Intraoperative electron beam radiotherapy and perioperative high-dose-rate brachytherapy in previously irradiated oligorecurrent gynecological cancer: clinical outcome analysis. Clin Transl Oncol 23, 1934–1941 (2021). https://doi.org/10.1007/s12094-021-02601-0

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  • DOI: https://doi.org/10.1007/s12094-021-02601-0

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