Intraoperative Radiation Therapy May Improve Survival For Certain Patients With Recurrent Cervical or Endometrial Cancer

For well-selected patients with recurrent or persistent cervical or endometrial cancer, intraoperative radiation therapy (IORT) is a feasible and safe option that may provide a benefit to survival.

Lindsay N Howlett, MD, Mayo Clinic, Rochester, Minnesota, and coauthors wrote, “While recent advances in systemic treatments such as immunotherapy, targeted agents, and antibody-drug conjugates have broadened palliative options for many patients [with cervical or endometrial cancer who experience a recurrence], there are unique cases in which radical resection and IORT can prolong survival and even cure a subset of patients.”

This multi-site retrospective cohort study included 80 patients who had undergone radical resection with IORT for recurrent or persistent endometrial (n = 35) or cervical cancer (n = 45)  at Mayo Clinic in Minnesota, Arizona, or Florida between June 2004 and May 2021. The predictors for postoperative complications and 3-year mortality were assessed. 

Of the 80 patients, there were 7 who did not receive IORT as they were determined to have sufficient surgical excision with negative margins. Among those who did receive IORT, the median dose was 1250 cGy. Postoperatively, there was 1 patient lost to follow up within 30 days. The overall survival at 3 years was 48.6%, with a median survival of 2.8 years. Within 30 days of operation, there were 16 patients with a grade 3 to 5 complication and 1 death had occurred. Factors that were associated with grade ≥3 complications included an ECOG performance score of 2 to 3 (odds ratio [OR], 18.00; P = .04), neoadjuvant chemotherapy and/or immunotherapy (OR, 6.98; P < .01), and pelvic sidewall involvement (OR, 8.80; P = .04). Factors associated with death within 3 years of surgery included ECOG performance score of 2 to 3 (hazard ratio [HR], 8.97; P < .01), neoadjuvant chemotherapy and/or immunotherapy (HR, 2.34; P < .03), whether exenteration was performed (HR, 2.64; P = .01), and positive resection margins (HR, 3.37; P < .01). 

Dr Howlett et al, concluded, “In this study, we found an appreciable survival gain is possible in patients with recurrent cervical and endometrial cancer treated with complex surgical resection and IORT.” However, they added, “patient selection is critical in balancing risks with potential benefits.”

Source:

Howlett LN, Fadadu PP, Grcevich LO, et al. Intraoperative radiation therapy for recurrent cervical and endometrial cancer: Predicting morbidity and mortality in a contemporary cohort. Cancers. 2024;16(21):3628. doi:10.3390/cancers16213628