CONCURRENT INTERSTITIAL RADIOTHERAPY AND INFUSIONAL CHEMOTHERAPY FOR RECURRENT GYNECOLOGIC MALIGNANCIES

Patients with unresectable locally recurrent gynecologic malignancies pose a difficult therapeutic challenge. Conventional therapies are fre quently unsuccessful and offer only marginal palliation. In this study , interstitial 192 iridium-needle implants and concomitant infusional 5-fluorouracil (5FU) and cisplatin (CDDP) or carboplatin (CBDCA) chemo therapy were used to treat 14 women with recurrent pelvic tumors. Mali gnancies of the cervix, endometrium ovary, tube and vulva are represen ted; all patients were heavily pretreated. Twenty interstitial implant s were performed in these 14 patients. Needle distributions and doses were individualized to accommodate the recurrent tumor volumes. Tumor responses were seen in 12 patients (six complete and six partial respo nses). Four women remain clinically free of disease and four are alive with disease at 18-34 months of follow-up. There were no severe acute toxicities, however, four patients have subsequently developed fistul ae associated with tumor progression. Although longer follow-up is req uired, the high response rate, wide applicability and acceptable toxic ity observed in this heavily pretreated patient population warrant fur ther study of combined interstitial radiation and chemotherapy.