Pelvic exenteration for cervix cancer: Would additional intraoperative interstitial brachytherapy improve survival?

Jonathan Jay Beitler, Patrick S. Anderson, Scott Wadler, Carolyn D. Runowicz, Mary Katherine Hayes, Abbie L. Fields, Brij Sood, Gary L. Goldberg

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Objective: Improved local control with the addition of brachytherapy to pelvic exenteration for recurrent cervical cancer has been reported to improve survival. We examined the sites of recurrence after pelvic exenteration to determine if these patients might have been salvaged by the improved local control promised by interstitial brachytherapy. We sought to identify risk factors available intraoperatively or perioperatively which might predict decreased local control. Methods: A retrospective review of 26 patients with recurrent cervical cancer who underwent total pelvic exenteration since 1988 at our institution was performed. Results: Overall, the mean follow-up was 29.5 months (range 6.1-81.6). Of the 26 patients, 14 had no evidence of disease (NED), 1 was alive with disease (AWD), 9 were dead of disease (DOD), and 2 died of unrelated causes (DOC). Seven of 26 patients (27%) had margins ≤ 5 mm, of whom 2 were NED, 4 DOD, and 1 AWD. Seven of 26 (27%) patients had lymphovascular involvement (LVI) or perineural invasion (PNI) with clear margins. Three of the seven with LVI or PNI and clear margins were NED, and four DOD. Of the 10 failures, 9 (90%) had close margins, PNI, or LVI. Conclusion: Our data reveal that 9 of 14 (64%) patients with close margins, LVI, or PNI were DOD or AWD, and 6 of 9 of those patients suffered local regional failure alone. Brachytherapy has the potential to cure 6 of 14 (43%) patients with these risk factors. Further study of brachytherapy at the time of pelvic extenteration is warranted.

Original languageEnglish (US)
Pages (from-to)143-148
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume38
Issue number1
DOIs
StatePublished - Apr 1 1997

Keywords

  • Brachytherapy
  • Cervix cancer
  • Lymphovascular involvement
  • Margins
  • Pelvic exenterations
  • Perineural invasion

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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  • Cite this

    Beitler, J. J., Anderson, P. S., Wadler, S., Runowicz, C. D., Hayes, M. K., Fields, A. L., Sood, B., & Goldberg, G. L. (1997). Pelvic exenteration for cervix cancer: Would additional intraoperative interstitial brachytherapy improve survival? International Journal of Radiation Oncology Biology Physics, 38(1), 143-148. https://doi.org/10.1016/S0360-3016(96)00585-8