Radical pelvic resection and intraoperative radiation therapy for recurrent endometrial cancer: Technique and analysis of outcomes

Sean Christopher Dowdy, Andrea Mariani, William Arthur Cliby, Michael Haddock, Ivy A Petersen, Franklin H. Sim, Karl C. Podratz

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Objective.: To describe the technique and assess outcomes and morbidity following radical resection combined with intraoperative electron radiation therapy (IOERT) in patients with recurrent endometrial cancer. Methods.: From 1986 to 2002, 25 patients received treatment including radical resection and IOERT for recurrent endometrioid, endometrial cancer. Relevant clinical information was extracted through retrospective chart review. Results.: Treatment prior to referral included radiation in 56% and either a secondary surgery or chemotherapy in 48%. External radiation (EBRT) was administered in addition to IOERT in 84%. Radical procedures performed at the time of IOERT included resection of the pelvic sidewall en bloc with the obturator nerve, external iliac vein, psoas, iliacus, or obturator internus muscles, ureter, or boney ileum. Seven patients required exenteration in combination with resection of the pelvic sidewall. The median IOERT dose was 1500 cGy (range 1000-2500 cGy). Overall five-year survival was 47% vs. 71% for those with a gross total resection but close margins. Two patients with recurrences limited to the para-aortic area are alive without evidence of disease at 54 and 71 months. Proportional hazards modeling showed concurrent EBRT, tumor size after resection, grade, and age to be associated with improved survival. The most common complications were peripheral neuropathy, functional ureteral obstruction, and fistula formation. Conclusions.: With an aggressive treatment approach including radical resection combined with IOERT, long-term survival is possible in a significant number of patients with localized recurrent endometrial cancer. Preoperative radiation paired with complete surgical resection utilizing extended procedures is paramount to achieving optimal outcomes.

Original languageEnglish (US)
Pages (from-to)280-286
Number of pages7
JournalGynecologic Oncology
Volume101
Issue number2
DOIs
StatePublished - May 2006
Externally publishedYes

Fingerprint

Endometrial Neoplasms
Radiotherapy
Electrons
Radiation
Survival
Obturator Nerve
Iliac Vein
Ureteral Obstruction
Peripheral Nervous System Diseases
Ureter
Ileum
Fistula
Therapeutics
Referral and Consultation
Morbidity
Recurrence
Drug Therapy
Muscles
Neoplasms

Keywords

  • Intraoperative radiation therapy
  • Radical pelvic resection
  • Recurrent endometrial cancer

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

@article{411ea32f6f6a4d48b1a446b26f3808f9,
title = "Radical pelvic resection and intraoperative radiation therapy for recurrent endometrial cancer: Technique and analysis of outcomes",
abstract = "Objective.: To describe the technique and assess outcomes and morbidity following radical resection combined with intraoperative electron radiation therapy (IOERT) in patients with recurrent endometrial cancer. Methods.: From 1986 to 2002, 25 patients received treatment including radical resection and IOERT for recurrent endometrioid, endometrial cancer. Relevant clinical information was extracted through retrospective chart review. Results.: Treatment prior to referral included radiation in 56{\%} and either a secondary surgery or chemotherapy in 48{\%}. External radiation (EBRT) was administered in addition to IOERT in 84{\%}. Radical procedures performed at the time of IOERT included resection of the pelvic sidewall en bloc with the obturator nerve, external iliac vein, psoas, iliacus, or obturator internus muscles, ureter, or boney ileum. Seven patients required exenteration in combination with resection of the pelvic sidewall. The median IOERT dose was 1500 cGy (range 1000-2500 cGy). Overall five-year survival was 47{\%} vs. 71{\%} for those with a gross total resection but close margins. Two patients with recurrences limited to the para-aortic area are alive without evidence of disease at 54 and 71 months. Proportional hazards modeling showed concurrent EBRT, tumor size after resection, grade, and age to be associated with improved survival. The most common complications were peripheral neuropathy, functional ureteral obstruction, and fistula formation. Conclusions.: With an aggressive treatment approach including radical resection combined with IOERT, long-term survival is possible in a significant number of patients with localized recurrent endometrial cancer. Preoperative radiation paired with complete surgical resection utilizing extended procedures is paramount to achieving optimal outcomes.",
keywords = "Intraoperative radiation therapy, Radical pelvic resection, Recurrent endometrial cancer",
author = "Dowdy, {Sean Christopher} and Andrea Mariani and Cliby, {William Arthur} and Michael Haddock and Petersen, {Ivy A} and Sim, {Franklin H.} and Podratz, {Karl C.}",
year = "2006",
month = "5",
doi = "10.1016/j.ygyno.2005.10.018",
language = "English (US)",
volume = "101",
pages = "280--286",
journal = "Gynecologic Oncology",
issn = "0090-8258",
publisher = "Academic Press Inc.",
number = "2",

}

TY - JOUR

T1 - Radical pelvic resection and intraoperative radiation therapy for recurrent endometrial cancer

T2 - Technique and analysis of outcomes

AU - Dowdy, Sean Christopher

AU - Mariani, Andrea

AU - Cliby, William Arthur

AU - Haddock, Michael

AU - Petersen, Ivy A

AU - Sim, Franklin H.

AU - Podratz, Karl C.

PY - 2006/5

Y1 - 2006/5

N2 - Objective.: To describe the technique and assess outcomes and morbidity following radical resection combined with intraoperative electron radiation therapy (IOERT) in patients with recurrent endometrial cancer. Methods.: From 1986 to 2002, 25 patients received treatment including radical resection and IOERT for recurrent endometrioid, endometrial cancer. Relevant clinical information was extracted through retrospective chart review. Results.: Treatment prior to referral included radiation in 56% and either a secondary surgery or chemotherapy in 48%. External radiation (EBRT) was administered in addition to IOERT in 84%. Radical procedures performed at the time of IOERT included resection of the pelvic sidewall en bloc with the obturator nerve, external iliac vein, psoas, iliacus, or obturator internus muscles, ureter, or boney ileum. Seven patients required exenteration in combination with resection of the pelvic sidewall. The median IOERT dose was 1500 cGy (range 1000-2500 cGy). Overall five-year survival was 47% vs. 71% for those with a gross total resection but close margins. Two patients with recurrences limited to the para-aortic area are alive without evidence of disease at 54 and 71 months. Proportional hazards modeling showed concurrent EBRT, tumor size after resection, grade, and age to be associated with improved survival. The most common complications were peripheral neuropathy, functional ureteral obstruction, and fistula formation. Conclusions.: With an aggressive treatment approach including radical resection combined with IOERT, long-term survival is possible in a significant number of patients with localized recurrent endometrial cancer. Preoperative radiation paired with complete surgical resection utilizing extended procedures is paramount to achieving optimal outcomes.

AB - Objective.: To describe the technique and assess outcomes and morbidity following radical resection combined with intraoperative electron radiation therapy (IOERT) in patients with recurrent endometrial cancer. Methods.: From 1986 to 2002, 25 patients received treatment including radical resection and IOERT for recurrent endometrioid, endometrial cancer. Relevant clinical information was extracted through retrospective chart review. Results.: Treatment prior to referral included radiation in 56% and either a secondary surgery or chemotherapy in 48%. External radiation (EBRT) was administered in addition to IOERT in 84%. Radical procedures performed at the time of IOERT included resection of the pelvic sidewall en bloc with the obturator nerve, external iliac vein, psoas, iliacus, or obturator internus muscles, ureter, or boney ileum. Seven patients required exenteration in combination with resection of the pelvic sidewall. The median IOERT dose was 1500 cGy (range 1000-2500 cGy). Overall five-year survival was 47% vs. 71% for those with a gross total resection but close margins. Two patients with recurrences limited to the para-aortic area are alive without evidence of disease at 54 and 71 months. Proportional hazards modeling showed concurrent EBRT, tumor size after resection, grade, and age to be associated with improved survival. The most common complications were peripheral neuropathy, functional ureteral obstruction, and fistula formation. Conclusions.: With an aggressive treatment approach including radical resection combined with IOERT, long-term survival is possible in a significant number of patients with localized recurrent endometrial cancer. Preoperative radiation paired with complete surgical resection utilizing extended procedures is paramount to achieving optimal outcomes.

KW - Intraoperative radiation therapy

KW - Radical pelvic resection

KW - Recurrent endometrial cancer

UR - http://www.scopus.com/inward/record.url?scp=33646422744&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33646422744&partnerID=8YFLogxK

U2 - 10.1016/j.ygyno.2005.10.018

DO - 10.1016/j.ygyno.2005.10.018

M3 - Article

C2 - 16321431

AN - SCOPUS:33646422744

VL - 101

SP - 280

EP - 286

JO - Gynecologic Oncology

JF - Gynecologic Oncology

SN - 0090-8258

IS - 2

ER -