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External-beam radiation therapy after surgical resection and intraoperative electron-beam radiation therapy for oligorecurrent gynecological cancer

Long-term outcome

Externe Strahlentherapie nach Resektion und intraoperative Strahlentherapie mit Elektronen bei gynäkologischen Oligorezidiven

Langzeitergebnisse

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Abstract

Purpose

The goal of the present study was to analyze prognostic factors in patients treated with external-beam radiation therapy (EBRT), surgical resection and intraoperative electron-beam radiotherapy (IOERT) for oligorecurrent gynecological cancer (ORGC).

Patients and methods

From January 1995 to December 2012, 61 patients with ORGC [uterine cervix (52 %), endometrial (30 %), ovarian (15 %), vagina (3 %)] underwent IOERT (12.5 Gy, range 10–15 Gy), and surgical resection to the pelvic (57 %) and paraaortic (43 %) recurrence tumor bed. In addition, 29 patients (48 %) also received EBRT (range 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 42 months (range 2–169 months). The 10-year rates for overall survival (OS) and locoregional control (LRC) were 17 and 65 %, respectively. On multivariate analysis, no tumor fragmentation (HR 0.22; p = 0.03), time interval from primary tumor diagnosis to locoregional recurrence (LRR) < 24 months (HR 4.02; p = 0.02) and no EBRT at the time of pelvic recurrence (HR 3.95; p = 0.02) retained significance with regard to LRR. Time interval from primary tumor to LRR < 24 months (HR 2.32; p = 0.02) and no EBRT at the time of pelvic recurrence (HR 3.77; p = 0.04) showed a significant association with OS after adjustment for other covariates.

Conclusion

External-beam radiation therapy at the time of pelvic recurrence, time interval for relapse ≥ 24 months and not multi-involved fragmented resection specimens are associated with improved LRC in patients with ORGC. As suggested from the present analysis a significant group of ORGC patients could potentially benefit from multimodality rescue treatment.

Zusammenfassung

Hintergrund und Ziel

Ziel der vorliegenden Studie war die Analyse prognostischer Faktoren bei gynäkologischen Krebspatientinnen mit einem Oligorezidiv („oligorecurrent gynecological cancer“, ORGC), welche mittels externer Radiotherapie („external-beam radiation therapy“, EBRT), Chirurgie und intraoperativer Radiotherapie („intraoperative electron-beam radiotherapy“, IOERT) behandelt wurden.

Patientinnen und Metoden

Zwischen Januar 1995 und Dezember 2012 wurden 61 gynäkologische Krebspatientinnen (52 % Zervix, 30 % Endometrium, 15 % Ovar, 3 % Vagina) an einem Oligorezidiv mittels IOERT (12,5 Gy; Spanne 10–15 Gy) und chirurgischer Resektion des pelvinen (57 %) oder paraaortischen (43 %) Tumorherds behandelt. Außerdem erhielten 29 Patientinnen eine EBRT (30,6–50,4 Gy). Die Überlebensrate wurde mit Hilfe der Kaplan-Meier-Methode ermittelt und Risikofaktoren wurden mittels univarianter und multivarianter Analyse identifiziert.

Ergebnisse

Die mediane Verlaufskontrollperiode für die Gesamtgruppe betrug 42 Monate (Spanne 2–169 Monate). Die 10-Jahres-Gesamtüberlebensrate und lokoregionale Kontrollrate betrugen jeweils 17 und 65 %. In der multivarianten Analyse behielten die Abwesenheit von Tumorfragmentation (HR 0,22; p = 0,03), eine Zeitspanne zwischen der primären Tumordiagnose und dem Lokalrezidiv < 24 Monate (HR 4,02; p = 0,02) und die Nichtverabreichung von EBRT im Falle eines pelvinen Lokalrezidivs (HR 3,95; p = 0,02) ihre Signifikanz in Bezug auf das rezidivfreie Intervall. Eine Zeitspanne zwischen der primären Tumordiagnose und dem Lokalrezidiv < 24 Monate (HR 2,32; p = 0,02) und die Nichtverabreichung von EBRT im Falle eines pelvinen Lokalrezidivs (HR 3,77; p = 0,04) behielten ihrerseits ihre Signifikanz in Bezug auf die Gesamtüberlebenszeit nach Justierung für andere Kovariablen.

Schlussfolgerungen

Die Verabreichung von EBRT im Falle eines pelvinen Lokalrezidivs, eine Zeitspanne ≥ 24 Monate bis zum Lokalrezidiv und eine einteilige, nichtfragmentierte Tumorresektion sagen eine signifikant bessere lokale Kontrolle bei ORCG-Patientinnen voraus. Hieraus lässt sich schließen, dass eine signifikante Untergruppe von ORGC-Patientinnen vorteilhaft mittels multimodaler Therapie behandelt werden könnte.

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Acknolwedgments

Supported in part by a grant from the Health Institute of Research Carlos III, Spanish Ministry of Science and Innovation (project code PI11-02908), and by the Spanish Ministry of Economy and Competitiveness (TEC2010-21619-C04, IPT-300000-2010-003, IPT-2012-0401-300000).

Compliance with ethical guidelines

Conflict of interest. C.V. Sole, F.A. Calvo, M.A. Lozano, L. Gonzalez-Bayon, C. Gonzalez-Sansegundo, A. Alvarez, S. Lizarraga, and J.L. García-Sabrido state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Authors and Affiliations

  1. Department of Oncology, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo, 46, 28007, Madrid, Spain

    C.V. Sole M.D., F.A. Calvo M.D., Ph.D., M.A. Lozano M.D. & C. Gonzalez-Sansegundo M.D.

  2. School of Medicine, Complutense University, Madrid, Spain

    C.V. Sole M.D., F.A. Calvo M.D., Ph.D. & J.L. García-Sabrido M.D., Ph.D.

  3. Service of Radiation Oncology, Instituto de Radiomedicina, Santiago, Chile

    C.V. Sole M.D.

  4. Service of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    M.A. Lozano M.D., C. Gonzalez-Sansegundo M.D. & A. Alvarez M.D.

  5. Service of General Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    L. Gonzalez-Bayon M.D., Ph.D. & J.L. García-Sabrido M.D., Ph.D.

  6. Department of Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    S. Lizarraga M.D. & J.L. García-Sabrido M.D., Ph.D.

  7. Institute of Research Investigation, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    C.V. Sole M.D., F.A. Calvo M.D., Ph.D., M.A. Lozano M.D., L. Gonzalez-Bayon M.D., Ph.D., C. Gonzalez-Sansegundo M.D., A. Alvarez M.D. & S. Lizarraga M.D.

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  1. C.V. Sole M.D.
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  2. F.A. Calvo M.D., Ph.D.
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  3. M.A. Lozano M.D.
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  4. L. Gonzalez-Bayon M.D., Ph.D.
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  6. A. Alvarez M.D.
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  7. S. Lizarraga M.D.
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  8. J.L. García-Sabrido M.D., Ph.D.
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Correspondence to C.V. Sole M.D..

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Sole, C., Calvo, F., Lozano, M. et al. External-beam radiation therapy after surgical resection and intraoperative electron-beam radiation therapy for oligorecurrent gynecological cancer. Strahlenther Onkol 190, 171–180 (2014). https://doi.org/10.1007/s00066-013-0472-5

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  • DOI: https://doi.org/10.1007/s00066-013-0472-5

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