Intraoperative Radiation Therapy in Gynecological Cancer

Abstract

Gynecological malignancies, mainly cervical uterine cancer, continue to present a high number of pelvic and para-aortic recurrences. Intraoperative radiation therapy (IORT) allows a precise therapeutic boost in the surgical bed in the cases in which removal of the tumor relapse is feasible. At the same time, IORT permits the exclusion of the radiosensitive organs from the irradiation field. While the first published gynecological IORT took place in 1905, the number of patients per year became stable and the published series are retrospective and limited. Recurrences are located in different areas with non-homogeneous prognostic and most of the published manuscripts are retrospective including a mix of primaries, sites and different types and results of salvage surgery. We have revised the present knowledge in this field and the main conclusion is that IORT increases the local control and, in selected cases, probably slightly the survival. Also, the quality of life is probably increased. Randomized trials that allow a breakthrough in the conclusions are highly unlikely to be performed in recurrent gynecological malignancies.