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The Role of Intraoperative Radiation Therapy (IORT) in the Treatment of Locally Advanced Gynecologic Malignancies

^a Vincent Gynecologic Oncology Service, ^b Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA

Correspondence: Marcela G. del Carmen, MD, VBK 113 Vincent Gynecology, 32 Fruit Street, Boston, Massachusetts 02114, USA. Telephone: 617-726-2429; Fax: 617-724-0257; e-mail: mdelcarmen{at}partners.org

The prognosis in women with locally advanced primary or recurrent gynecologic malignancies is rather poor. Doses of external beam radiation necessary to treat gross or microscopic recurrence among patients surgically treated or previously irradiated exceed what is tolerated by normal structures. In this group of patients, intraoperative radiation therapy (IORT) can be utilized to maximize local tumor control, minimizing the radiation exposure of dose-limiting surrounding structures. Review of the available literature indicates that IORT may improve long-term local control and overall survival in women with pelvic sidewall and/or para-aortic nodal recurrence. The most encouraging results have been reported in the cases of microscopic residual disease, following surgical debulking.

Key Words. Intraoperative radiation therapy • Advanced gynecologic malignancies • Primary disease • Recurrent disease • External beam radiation therapy • Brachytherapy