Intraoperative radiation therapy in the treatment of pelvic gynecologic malignancies: A review of fifteen cases

Objective. The aim of this study was to review the experience with intraope rative radiation therapy (IORT) in the treatment of gynecologic pelvic mali gnancies at the Massachusetts General Hospital. Methods. From July 3, 1996, through July 28, 1999, 15 patients were treated with IORT for gynecologic malignancies in a dedicated IORT operating room suite at the Massachusetts General Hospital. Hospital medical records, radi ation oncology records, and office charts were reviewed on all patients tre ated with IORT. IORT was given in the presence of positive surgical margins and where the doses needed for adjuvant postoperative external beam radiot herapy (EBRT) would exceed those tolerated by normal structures. One patien t presented with primary disease and 14 with local or regional recurrence. Follow-up time ranged from 3 to 36 months. Results. Treatment in conjunction with IORT included surgery only (7 patien ts); preoperative EBRT, preoperative brachytherapy, and surgery (1 patient) ; preoperative chemotherapy and surgery (2 patients); and surgery and posto perative chemotherapy (5 patients). IORT doses ranged from 10 to 22.5 Gy. A t the completion of this review, 4 patients (26.6%) have died, 6 (40%) are alive and free of disease, and 5 (33%) are alive with disease persistence o r relapse. Of the 10 patients with gross total resection, 5 are alive and f ree of disease. Of the 5 women with gross residual disease at the time of I ORT, only 1 is alive and free of disease. Conclusions. The volume of residual disease prior to IORT may be an importa nt prognostic indicator for disease relapse. Both local recurrence and dist ant metastasis were more common among patients with gross residual disease at the time of IORT. Our institutional experience with IORT further support s the importance of optimal surgical resection. (C) 2000 Academic Press.