RADICAL TUMOR DEBULKING AND INTRAOPERATIV E RADIATION-THERAPY (IORT) FOR PELVIC RECURRENCES OF GYNECOLOGICAL CARCINOMAS

In patients with pelvic recurrences the therapeutic dilemma resides in the fact that despite radical tumor debulking tumor control can rarel y be achieved. The impact of tumor debulking combined with IORT on loc al tumor control and overall survival was evaluated in patients with a dvanced disease. Patients and Methods: Between Januar 1992 and August 1995, 28 patients with pelvic recurrences were selected for tumor debu lking plus IORT. Due to intraperitoneal metastases 9 patients had no I ORT. Multi-organ resection was performed in 8 of 19 patients treated w ith tumor debulking plus IORT. In previously irradiated women (n = 10) an IORT dose of 18 Gy, and in patients without prior irradiation 15 G y plus 40 Gy external beam irradiation was given. Results: After a med ian follow-up of 26 months a significant difference (p = 0.032) was ob served between those patients with (med. OAS 8 months) and without pri or irradiation (med. OAS 16 months). Median OAS was 9 months in patien ts after complete resection (n = 3), and 6.5 months after non-complete resection (p = 0.003). There were only two recurrences in the irradia tion field. No perioperative complications were observed. One neuropat hy (sensitive) occurred after 6 months. Conclusions: Using multi-modal ity approaches in pretreated patients with pelvic recurrences an good local tumor control could be achieved without increased mortality and morbidity. However, answers to a number of open questions are still la cking, such as the tolerance of healthy tissue to high doses of extern al irradiation with or without brachytherapy as boost technique, or qu estions related to the optimisation of individual selection criteria, resp. to the possible integration of IORT into the therapeutic concept of primary advanced gynecologic malignancies. Further optimisation of multi-modality treatment with maximal interdisciplinary effort will b e essential.