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



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


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.


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.


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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  1. Höckel M, et al. Five-year experience with combined operative and radiotherapeutic treatment of recurrent gynecologic tumors infiltrating the pelvic wall. Cancer. 1996;77:1918–33.

    Article  Google Scholar 

  2. Beitler JJ, et al. Pelvic exenteration for cervix cancer: Would additional intraoperative interstitial brachytherapy improve survival? Int J Radiat Oncol Biol Phys. 1997;38:143–8.

    Article  CAS  Google Scholar 

  3. Cambeiro M, et al. Salvage surgery and radiotherapy including intraoperative electron radiotherapy in isolated locally recurrent tumors: predictors of outcome. Radiother Oncol. 2015;116:316–22.

    Article  Google Scholar 

  4. Sole CV, et al. Single-institution multidisciplinary management of locoregional oligo-recurrent pelvic malignancies: long-term outcome analysis. Ann Surg Oncol. 2015;22:1247–55.

    Article  Google Scholar 

  5. Martínez-Monge R, Jurado M, Cambeiro M, Valero J, Villafranca E, Alcázar JL. Perioperative high-dose-rate brachytherapy in locally advanced and recurrent gynecologic cancer: initial results of a phase II trial. Brachytherapy. 2006;5:203–10.

    Article  Google Scholar 

  6. Martínez-Monge R, et al. Perioperative high-dose-rate brachytherapy in locally advanced and recurrent gynecological cancer: final results of a phase II trial. Brachytherapy. 2018;17:734–41.

    Article  Google Scholar 

  7. Calvo FA, Santos M, Brady LW. Intraoperative radiotherapy: rationale and program development. Berlin: Springer; 1992.

    Book  Google Scholar 

  8. Höckel M. Laterally extended endopelvic resection: surgical treatment of infrailiac pelvic wall recurrences of gynecologic malignancies. Am J Obstet Gynecol. 1999;180:306–12.

    Article  Google Scholar 

  9. Barney BM, et al. Intraoperative electron beam radiotherapy (IOERT) in the management of locally advanced or recurrent cervical cancer. Radiat Oncol. 2013;8:1–9.

    Article  Google Scholar 

  10. Gillette EL, Powers BE, McChesney SL, Park RD, Withrow SJ. Response of aorta and branch arteries to experimental intraoperative irradiation. Radiat Oncol. 1989;17:1247–55.

    CAS  Google Scholar 

  11. Kinsella TJ, et al. Threshold dose for peripheral neuropathy following intraoperative radiotherapy (IORT) in a large animal model. Radiat Oncol. 1991;20:697–701.

    CAS  Google Scholar 

  12. Sindelar WF, Kinsella TJ, Chen PW, et al. Intraoperative radiotherapy in retroperitoneal sarcomas final results of a prospective, randomized, clinical trial. JAMA. 1993;128:402–10.

    CAS  Google Scholar 

  13. Haddock MG, et al. Intraoperative irradiation for locally recurrent colorectal cancer in previously irradiated patients. Radiat Oncol. 2001;49:1267–74.

    CAS  Google Scholar 

  14. Backes FJ, et al. Does intra-operative radiation at the time of pelvic exenteration improve survival for patients with recurrent, previously irradiated cervical, vaginal, or vulvar cancer? Gynecol Oncol. 2014;135:95–9.

    Article  Google Scholar 

  15. Calvo FA, et al. Intraoperative electron beam radiotherapy and extended surgical resection for gynecological pelvic recurrent malignancies with and without external beam radiation therapy: long-term outcomes. Gynecol Oncol. 2013;130:537–44.

    Article  CAS  Google Scholar 

  16. Mahé MA, et al. Intraoperative radiation therapy in recurrent carcinoma of the uterine cervix: report of the French intraoperative group on 70 patients. Int J Radiat Oncol Biol Phys. 1996;34:21–6.

    Article  Google Scholar 

  17. Coelho TM, et al. Intraoperative radiation therapy for the treatment of recurrent retroperitoneal and pelvic tumors: a single-institution analysis. Radiat Oncol. 2018;13:1–13.

    Article  Google Scholar 

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Correspondence to R. Martínez-Monge.

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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).

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  • Gynecological cancer
  • Recurrence
  • Perioperative high-dose-rate brachytherapy
  • Intraoperative electron beam radiotherapy
  • External beam radiation therapy