INTRAOPERATIVE RADIOTHERAPY IN RECURRENT GYNECOLOGICAL CANCER

A retrospective analysis to assess the feasibility and clinical tolera nce of intraoperative radiotherapy (IORT) in the treatment of recurren t gynecologic cancer is reported. From February 1985 to September 1992 , 26 patients with recurrent gynecologic tumors entered this trial. Th e clinical experience comprises two different categories of disease si tuations: tumors relapsing after full dose radiation therapy (group I) and recurrent disease to previous surgery (group II). Cervical carcin oma was the initial tumor site of involvement in 18 patients (69%). Tr eatment consisted in maximal surgical resection + IORT boost (10-25 Gy ) to the high-risk areas for recurrence. Non previously irradiated pat ients also received external beam irradiation (EBRT) (+/- chemotherapy ) pre- or postoperatively. IORT-related toxicity was one episode of mo tor neuropathy. Local control rates have been 33% and 77%, respectivel y in groups I and II. The 4-year actuarial overall survival in Group I is 7% and 6-year actuarial overall survival in Group II is 33%. The a ddition of IORT to surgical debulking achieves modest local control an d long-term survival rates if tumor-free margins cannot be obtained in previously irradiated patients. Combined EBRT (+/- chemotherapy) maxi mal surgical resection plus IORT could render some long-term survivors among those surgical recurrent patients not candidates for radical su rgery with curative intent.