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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