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Table 1 IORT studies for endometrial and cervical cancer

From: Intraoperative radiotherapy in gynaecological and genito-urinary malignancies: focus on endometrial, cervical, renal, bladder and prostate cancers

Reference

N.pts

Type of cancer

Primary/recurrent

EBRT N. pts Dose (Gy)

IORT dose (Gy)

Technique

Median follow-up months(range)

Local Control

Overall Survival

Toxicity

Sole [7]

61

Uterus 18 Cervix 32 Other 11

Pelvic recurrent 35 (57%) Paraortic recurrent 26 (43%)

Mean 31 Gy (29–45)

R0: 10–12.5 Gy R1: 15 Gy

IOERT

42 (2–169)

5-years 65%

5-years 42%

RTOG acute ≥ G3: 23 RTOG late ≥ G3: GI 8 GU 3 Neuropathy 1

Foley [8]

32

Cervix 21 Uterus 6 Other 5

Pelvic recurrent 26 (81%) Primary 6 (19%)

NA

Mean 13.5 Gy (10–22.5)

IOERT

Median 26 (3–196)

5-years R1 73% 5 years R2 71%

5-years 70% R1 77% R2 55%

≥G3 47% 5 IORT-related GU 2 Bone 1 Lymphedema 2

Backes

[9]

32 21 IORT

Cervix 21 Other 11

Recurrent 32 (100%)

6 pts, mean 26 Gy (10–40)

Median 17.5 Gy (10–20 Gy)

IOERT

HDR IORT

NA

Median PE + IORT 10 months

LEER + IORT 9 months PE 33 months

Median PE + IORT 10 months LEER + IORT 17 months PE 41 months

NA

Barney

[10]

86

Cervix

Pelvic recurrent 73 (85%) Primary 13 (15%)

61 pts (71%) No prior RT: median 45 Gy Prior RT: median 39.6 Gy

median 15 Gy (6–25 Gy)

IOERT

32 (1–306)

3-years 62%: 70% primary 61% recurrent

3-years 25%

≥G3 GI 4 GU 1 Neuropathy 1 Other 4

Calvo

[11]

35

Uterus 7 Cervix 20 Other 8

Pelvic recurrent 35 (100%)

16 pts: 45 Gy no previous RT 30.6 Gy previous RT

R0: 10–12.5 Gy R1: 15 Gy

IOERT

46 (3–169)

5-years 58%

5-years 42%

acute ≥3: 14 late ≥3: GI 5 GU 2 Neuropathy 1

Giorda

[12]

35

Cervix

Primary 35 (100%)

neoadj 50.4 Gy

Mean 11 Gy (10–15)

IOERT

NA

2-years 89%

5-years 49%

Peri/post-surgery GU 10

Tran

[13]

36

Cervix 17 Uterus 11 Other 8

Recurrent 32 (88%)

18 pts (50%) mean 44 Gy

Median 11.5 Gy (6–17.5)

Orthovoltage-IORT

Mean 50 (2–198)

5-years 44% Cervix 45% Uterus 58%

5-years 42%

≥G3 10 pts 28%

Dowdy

[14]

25

Uterus

Recurrent 25 (100%)

21 pts 45 Gy

Median 15 Gy (10–25 Gy)

IOERT

Median 34

84%

5-years: 71% R0

47% R1

0% R2

Neuropathy 8 GU 5 Fistulas 5 Bone fractures 2

Awtrey

[15]

27

Uterus

Pelvic Recurrent 27 (100%)

12 pts

NA

IOERT

9 pts

Median 24 (5–84)

NA

2-years 78%

NA

Martinez-Monge

[16]

67

Cervix

Pelvic Recurrent 36 (54%) Primary 31 (46%)

36 pts : 45 Gy

Primary: 12 Gy median (10–25) Recurrent: 15 Gy (10–20)

IOERT

Primary: 58 (8–144) Recurrent 19 (1–138)

10-year 69%: 93% primary 47% recurrent

10-year 35%; 58% primary 14% recurrent

15% IORT related

Gemignani

[17]

17

Cervix 9 Uterus 7 Other 1

Recurrent 17 (100%)

2 pts dose NA

Mean 14Gy (12-15Gy)

HDR-IORT

20 (3–65)

67

54

NA

DelCarmen

[18]

15

Cervix 5 Uterus 3 Other 7

Pelvic Recurrent 14 (93%) Primary 1 (7%)

-

10-22.5 Gy

IOERT

(3–36)

54%

74%

Neuropathy 4 GU 3 Lymphedema 2

Garton

[19]

39

Cervix 22 Uterus 10 Other 7

Pelvic Recurrent 36 (92%) Primary 3 (8%)

28 pts Median 45 Gy (1–67)

Median 17.3 Gy (10–25 Gy)

IOERT

Median 25 (6–125)

5-years 67%

5-years 32%

≥G3 14 (36%) IORT related 6

Mahè

[20]

70

Cervix

Pelvic Recurrent 70 (100%)

30 pts (20–45)

R0 mean 18 (10–25) R1-biopsy mean 19 (10–30)

IOERT

Mean 15 (2–69)

21% R0 27% R1-2 11%

3-years 8%

10-IORT related GI 1 GU 4 Neuropathy 5

Stelzer

[21]

22

Cervix

Pelvic Recurrent 22 (100%)

6 pts: 26–50 Gy 7 pts: 45–62.4 Gy

22 Gy median (14–27.8 Gy)

IOERT

Minimum 15 months

5-years 48%

5-years 43%

Neuropathy 7

  1. Pts patients, IORT Intraoperative radiotherapy, IOERT intraoperative electron radiotherapy, EBRT external beam radiotherapy, GU genitourinary GI gastrointestinal, NA not available, R0 negative margins, R1 microscopic residual disease, R2 macroscopic residual disease