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oai:recercat.cat:11351/75942025-10-24T10:33:33Zcom_2072_378070com_2072_378040col_2072_378092

Radical Extirpation With Intraoperative Radiotherapy for Locally Recurrent Gynecologic Cancer: An Institutional Review Delara, Ritchie Yang, Jie Suarez Salvador, Elena Vora, Sujay Magriña, Javier Butler, Kristina Institut Català de la Salut [Delara R, Yang J, Magriña J, Butler K] Department of Obstetrics and Gynecology, Mayo Clinic, Phoenix, AZ. [Suárez-Salvador E] Department of Obstetrics and Gynecology, Mayo Clinic, Phoenix, AZ. Servei de Ginecologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Vora S] Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ Vall d'Hebron Barcelona Hospital Campus Aparell genital femení - Càncer - Cirurgia Aparell genital femení - Càncer - Radioteràpia Extirpació (Cirurgia) DISEASES::Neoplasms::Neoplasms by Site::Urogenital Neoplasms::Genital Neoplasms, Female Other subheadings::Other subheadings::Other subheadings::/radiotherapy DISEASES::Neoplasms::Neoplastic Processes::Neoplasm Recurrence, Local Other subheadings::Other subheadings::Other subheadings::/surgery ENFERMEDADES::neoplasias::neoplasias por localización::neoplasias urogenitales::neoplasias de los genitales femeninos Otros calificadores::Otros calificadores::Otros calificadores::/radioterapia ENFERMEDADES::neoplasias::procesos neoplásicos::recurrencia neoplásica local Otros calificadores::Otros calificadores::Otros calificadores::/cirugía Intraoperative radiotherapy; Overall survival; Progression-free survival Radioterapia intraoperatoria; Supervivencia global; Supervivencia libre de progresión Radioteràpia intraoperatòria; Supervivència global; Supervivència lliure de progressió Objective To report survival outcomes in patients with locally recurrent gynecologic cancers managed with curative-intent radical extirpation, perioperative external beam radiotherapy, and intraoperative radiotherapy (IORT). Patients and Methods We conducted a retrospective cohort analysis of 44 patients with locally recurrent gynecologic cancer treated at a single tertiary-care center (Mayo Clinic in Arizona) over a 15-year period (January 1, 2004, to July 31, 2019). This cohort included patients with uterine (n=21, 47.7%), ovarian (n=3, 6.8%), cervical (n=11, 25.0%), vaginal (n=2, 4.5%), vulvar (n=1, 2.3%), and unknown primary (n=6, 13.6%) cancer. Curative-intent radical extirpation included pelvic exenteration (n=13, 29.5%), laterally extended endopelvic resection (n=22, 50.0%), excision of para-aortic lymph node metastasis (n=8, 18.2%), and radical vaginectomy (n=1, 2.3%). Of the 44 patients in our cohort, 37 (84.1%) received IORT and 7 (15.9%) had intended to receive IORT but did not receive it. Results The median follow-up for the 44 patients was 12 months (range, 1 to 161 months). For patients who received IORT, the median progression-free survival (PFS) and overall survival (OS) were 13 and 21 months, respectively, and the 3-year cumulative incidence of central, locoregional, and distant recurrence was 27.0% (10 of 37), 40.5% (15 of 37), and 37.8% (14 of 37), respectively. Surgical margins were classified as negative (28 of 44, 63.6%), microscopic (11 of 44, 25.0%), or macroscopic (5 of 44, 11.4%). Negative, microscopic, and macroscopic surgical margins resulted in 3-year PFS of 51.8%, 20.5%, and 0%, respectively (P=.01) and 3-year OS of 62.9%, 20.0%, and 0%, respectively (P=.035). Progression-free survival (P=.69) and OS (P=.88) were not different between patients with negative surgical margins who received (n=21) and did not receive (n=7) IORT. Ten of 37 patients (27.0%) had development of grade 3 or higher toxicities, with 1 death due to sepsis. Conclusion Complete tumor resection at the time of curative-intent radical extirpation achieved higher rates of PFS and OS regardless of IORT administration. 2022-05-31T07:46:45Z 2022-05-31T07:46:45Z 2021-11-19 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Delara R, Yang J, Suárez-Salvador E, Vora S, Magriña J, Butler K, et al. Radical Extirpation With Intraoperative Radiotherapy for Locally Recurrent Gynecologic Cancer: An Institutional Review. Mayo Clin Proc Innov Qual Outcomes. 2021 Nov 19;5(6):1081–8. 2542-4548 https://hdl.handle.net/11351/7594 10.1016/j.mayocpiqo.2021.10.004 34841199 http://hdl.handle.net/11351/7594 eng Mayo Clinic Proceedings: Innovations, Quality & Outcomes;5(6) https://doi.org/10.1016/j.mayocpiqo.2021.10.004 Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess application/pdf Elsevier Scientia