Autores: Calvo Manuel, Felipe; Sole, C. V. (Autor de correspondencia); Lozano, M. A.; Gonzalez-Bayon, L.; Gonzalez-Sansegundo, C.; Alvarez, A. ; Blanco, J.; Calin, A. ; Lizarraga, S.; Garcia-Sabrido, J. L.
Resumen:
Objective. To analyze prognostic factors in patients treated with intraoperative electrons containing resective surgical rescue of locally recurrent gynecological cancer (LRGC). Methods. From January 1995 to December 2012, 35 patients with LRGC [uterine cervix (57%), endometrial (20%), ovarian (17%), vagina (6%)] underwent extended [multiorgan (54%), bone (9%), soft tissue (54%), vascular (14%)] surgery and intraoperative electron-beam radiation therapy [IOERT (10-15 Gy)] to the pelvic recurrence tumor bed. Sixteen (46%) patients also received external beam radiation therapy [EBRT (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 46 months (range, 3-169). Ten-year rates for locoregional control (LRC) and overall survival (OS) were 58 and 16%, respectively. On multivariate analysis non-EBRT at the time of pelvic re-recurrence [HR 4.15; p = 0.02], no tumor fragmentation [HR 0.13; p = 0.05] and time interval from primary tumor to LRR < 24 months [HR 5.16; p = 0.01], retained significance with regard to LRR. Non-EBRT at the time of pelvic re-recurrence [HR 4.18; p = 0.02] and time interval from primary tumor to LRR < 24 months [HR 6.67; p = 0.02] showed a significant association with OS after adjustment for other covariates. Conclusions. EBRT treatment integrated for rescue, time interval for relapse >= 24 months, and not multi-involved fragmented resection specimens are associated with improved LRC in patients with LRGC in the pelvis. Present results suggest that a significant group of patients may benefit from EBRT treatment integrated with extended surgery and IOERT. (C) 2013 Elsevier Inc. All rights reserved.
