Outcome of patients with local recurrent gynecologic malignancies after resection combined with intraoperative electron radiation therapy (IOERT)
Identifieur interne : 000D23 ( Main/Exploration ); précédent : 000D22; suivant : 000D24Outcome of patients with local recurrent gynecologic malignancies after resection combined with intraoperative electron radiation therapy (IOERT)
Auteurs : Nathalie Arians [Allemagne] ; Robert Foerster [Allemagne] ; Joachim Rom [Allemagne] ; Matthias Uhl [Allemagne] ; Falk Roeder [Allemagne] ; Jürgen Debus [Allemagne] ; Katja Lindel [Allemagne]Source :
- Radiation Oncology (London, England) [ 1748-717X ] ; 2016.
Abstract
Treatment of recurrent gynecologic cancer is a challenging issue. Aim of the study was to investigate clinical features and outcomes of patients with recurrent gynecologic malignancies who underwent resection including IOERT (intraoperative electron radiation therapy) with regard to clinical outcome and potential predictive factors or subgroups that benefit most from this radical treatment regime.
A total of 36 patients with recurrent gynecologic malignancies (cervical (
Patient characteristics and outcomes were assessed. Survival data was analyzed using the Kaplan-Meier-method and log-rank-test, categorical variables were analyzed with chi-square-method.
For the entire cohort 1-/2-/5-year Overall Survival (OS) was 65.3 %/36.2 %/21.7 %. Patients with endometrial, cervical, and vulvar carcinoma had a 1-/2-/5-year OS of 83.3 %/62.5 %/50 %, 44.5 %/25.4 %/6.4 %, and 83.3 %/16.7 %/16.7 %, respectively. Patients with endometrial carcinoma showed a significantly better OS (
1-/2-/5-year Local Progression-free Survival (LPFS) for the entire cohort was 44.1 %/28 %/21 % with 76.2 %/61 %/40.6 % for endometrial, 17.2 %/0 %/0 % for cervical, and 40 %/20 %/20 % for vulvar cancer, respectively. Patients with endometrial cancer showed a significantly (
1-/2-/5-year Distant Progression-free Survival (DPFS) for the entire cohort was 53.1 %/46.5 %/38.7 % with 74.1 %/74.1 %/74.1 % for endometrial, 36.7 %/36.7 %/0 % for cervical, and 60 %/30 %/30 % for vulvar cancer, respectively. There was a significantly better DPFS for older patients (
The radical procedure of resection combined with IOERT seems to be a valid curative treatment option for patients with recurrent endometrial carcinoma with 5-year survival rates of 50 %. For patients with cervical or vulvar cancer this treatment should be considered a rather palliative one and must be weighted carefully against other treatment options like chemotherapy, targeted therapies or new highly conformal radiotherapy techniques.
The online version of this article (doi:10.1186/s13014-016-0622-x) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s13014-016-0622-x
PubMed: 26988089
PubMed Central: 4797348
Affiliations:
- Allemagne
- Bade-Wurtemberg, Bavière, District de Haute-Bavière, District de Karlsruhe
- Heidelberg, Munich
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nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff2">Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Foerster, Robert" sort="Foerster, Robert" uniqKey="Foerster R" first="Robert" last="Foerster">Robert Foerster</name><affiliation wicri:level="3"><nlm:aff id="Aff1">National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff2">Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Rom, Joachim" sort="Rom, Joachim" uniqKey="Rom J" first="Joachim" last="Rom">Joachim Rom</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Uhl, Matthias" sort="Uhl, Matthias" uniqKey="Uhl M" first="Matthias" last="Uhl">Matthias Uhl</name><affiliation wicri:level="3"><nlm:aff id="Aff1">National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff2">Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Roeder, Falk" sort="Roeder, Falk" uniqKey="Roeder F" first="Falk" last="Roeder">Falk Roeder</name><affiliation wicri:level="3"><nlm:aff id="Aff4">Department of Radiation Oncology, University Hospital Munich (LMU), Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Radiation Oncology, University Hospital Munich (LMU), Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff5">CCU Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>CCU Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Debus, Jurgen" sort="Debus, Jurgen" uniqKey="Debus J" first="Jürgen" last="Debus">Jürgen Debus</name><affiliation wicri:level="3"><nlm:aff id="Aff1">National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff2">Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Lindel, Katja" sort="Lindel, Katja" uniqKey="Lindel K" first="Katja" last="Lindel">Katja Lindel</name><affiliation wicri:level="3"><nlm:aff id="Aff1">National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff2">Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author></analytic><series><title level="j">Radiation Oncology (London, England)</title><idno type="eISSN">1748-717X</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Treatment of recurrent gynecologic cancer is a challenging issue. Aim of the study was to investigate clinical features and outcomes of patients with recurrent gynecologic malignancies who underwent resection including IOERT (intraoperative electron radiation therapy) with regard to clinical outcome and potential predictive factors or subgroups that benefit most from this radical treatment regime.</p></sec><sec><title>Methods</title><p>A total of 36 patients with recurrent gynecologic malignancies (cervical (<italic>n</italic> = 18), endometrial (<italic>n</italic> = 12) or vulvar cancer (<italic>n</italic> = 6)) were retrospectively identified through hospital databases in accordance with institutional ethical policies.</p><p>Patient characteristics and outcomes were assessed. Survival data was analyzed using the Kaplan-Meier-method and log-rank-test, categorical variables were analyzed with chi-square-method.</p></sec><sec><title>Results</title><p>For the entire cohort 1-/2-/5-year Overall Survival (OS) was 65.3 %/36.2 %/21.7 %. Patients with endometrial, cervical, and vulvar carcinoma had a 1-/2-/5-year OS of 83.3 %/62.5 %/50 %, 44.5 %/25.4 %/6.4 %, and 83.3 %/16.7 %/16.7 %, respectively. Patients with endometrial carcinoma showed a significantly better OS (<italic>p</italic> = 0.038).</p><p>1-/2-/5-year Local Progression-free Survival (LPFS) for the entire cohort was 44.1 %/28 %/21 % with 76.2 %/61 %/40.6 % for endometrial, 17.2 %/0 %/0 % for cervical, and 40 %/20 %/20 % for vulvar cancer, respectively. Patients with endometrial cancer showed a significantly (<italic>p</italic> = 0.017) and older patients a trend (<italic>p</italic> = 0.059) for a better LPFS.</p><p>1-/2-/5-year Distant Progression-free Survival (DPFS) for the entire cohort was 53.1 %/46.5 %/38.7 % with 74.1 %/74.1 %/74.1 % for endometrial, 36.7 %/36.7 %/0 % for cervical, and 60 %/30 %/30 % for vulvar cancer, respectively. There was a significantly better DPFS for older patients (<italic>p</italic> = 0.015) and a trend for a better DPFS for patients with endometrial carcinoma (<italic>p</italic> = 0.075).</p></sec><sec><title>Conclusion</title><p>The radical procedure of resection combined with IOERT seems to be a valid curative treatment option for patients with recurrent endometrial carcinoma with 5-year survival rates of 50 %. For patients with cervical or vulvar cancer this treatment should be considered a rather palliative one and must be weighted carefully against other treatment options like chemotherapy, targeted therapies or new highly conformal radiotherapy techniques.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/s13014-016-0622-x) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Backes, Fj" uniqKey="Backes F">FJ Backes</name></author><author><name sortKey="Martin, Dd" uniqKey="Martin D">DD Martin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Amant, F" uniqKey="Amant F">F Amant</name></author><author><name sortKey="Mirza, Mr" uniqKey="Mirza M">MR Mirza</name></author><author><name sortKey="Creutzberg, Cl" uniqKey="Creutzberg C">CL 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Leer</name></author><author><name sortKey="Cleton, Fj" uniqKey="Cleton F">FJ Cleton</name></author><author><name sortKey="Hermans, J" uniqKey="Hermans J">J Hermans</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Deutsch, M" uniqKey="Deutsch M">M Deutsch</name></author><author><name sortKey="Parsons, Ja" uniqKey="Parsons J">JA Parsons</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hunter, Dj" uniqKey="Hunter D">DJ Hunter</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Burger, Mp" uniqKey="Burger M">MP Burger</name></author><author><name sortKey="Hollema, H" uniqKey="Hollema H">H Hollema</name></author><author><name sortKey="Emanuels, Ag" uniqKey="Emanuels A">AG Emanuels</name></author><author><name sortKey="Krans, M" uniqKey="Krans M">M Krans</name></author><author><name sortKey="Pras, E" uniqKey="Pras E">E Pras</name></author><author><name sortKey="Bouma, J" uniqKey="Bouma J">J Bouma</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Berek, Js" uniqKey="Berek J">JS Berek</name></author><author><name sortKey="Howe, C" uniqKey="Howe C">C Howe</name></author><author><name sortKey="Lagasse, Ld" uniqKey="Lagasse L">LD Lagasse</name></author><author><name sortKey="Hacker, Nf" uniqKey="Hacker N">NF Hacker</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Moore, Dh" uniqKey="Moore D">DH Moore</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Moore, Dh" uniqKey="Moore D">DH Moore</name></author><author><name sortKey="Tian, C" uniqKey="Tian C">C Tian</name></author><author><name sortKey="Monk, Bj" uniqKey="Monk B">BJ Monk</name></author><author><name sortKey="Long, Hj" uniqKey="Long H">HJ Long</name></author><author><name sortKey="Omura, Ga" uniqKey="Omura G">GA Omura</name></author><author><name sortKey="Bloss, Jd" uniqKey="Bloss J">JD Bloss</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Morris, M" uniqKey="Morris M">M Morris</name></author><author><name sortKey="Alvarez, Rd" uniqKey="Alvarez R">RD Alvarez</name></author><author><name sortKey="Kinney, Wk" uniqKey="Kinney W">WK Kinney</name></author><author><name sortKey="Wilson, To" uniqKey="Wilson T">TO Wilson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fleming, Gf" uniqKey="Fleming G">GF Fleming</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Foley, Ow" uniqKey="Foley O">OW Foley</name></author><author><name sortKey="Rauh Hain, Ja" uniqKey="Rauh Hain J">JA Rauh-Hain</name></author><author><name sortKey="Del Carmen, Mg" uniqKey="Del Carmen M">MG del Carmen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Haddock, Mg" uniqKey="Haddock M">MG Haddock</name></author><author><name sortKey="Petersen, Ia" uniqKey="Petersen I">IA Petersen</name></author><author><name sortKey="Webb, Mj" uniqKey="Webb M">MJ Webb</name></author><author><name sortKey="Wilson, To" uniqKey="Wilson T">TO Wilson</name></author><author><name sortKey="Podratz, Kc" uniqKey="Podratz K">KC Podratz</name></author><author><name sortKey="Gunderson, Ll" uniqKey="Gunderson L">LL Gunderson</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Jurado, M" uniqKey="Jurado M">M Jurado</name></author><author><name sortKey="Alcazar, Jl" uniqKey="Alcazar J">JL Alcázar</name></author><author><name sortKey="Martinez Monge, R" uniqKey="Martinez Monge R">R Martinez-Monge</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hockel, M" uniqKey="Hockel M">M Höckel</name></author><author><name sortKey="Dornhofer, N" uniqKey="Dornhofer N">N Dornhöfer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Thomas, Gm" uniqKey="Thomas G">GM Thomas</name></author><author><name sortKey="Dembo, Aj" uniqKey="Dembo A">AJ Dembo</name></author><author><name sortKey="Myhr, T" uniqKey="Myhr T">T Myhr</name></author><author><name sortKey="Black, B" uniqKey="Black B">B Black</name></author><author><name sortKey="Pringle, Jf" uniqKey="Pringle J">JF Pringle</name></author><author><name sortKey="Rawlings, G" uniqKey="Rawlings G">G Rawlings</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Allemagne</li></country><region><li>Bade-Wurtemberg</li><li>Bavière</li><li>District de Haute-Bavière</li><li>District de Karlsruhe</li></region><settlement><li>Heidelberg</li><li>Munich</li></settlement></list><tree><country name="Allemagne"><region name="Bade-Wurtemberg"><name sortKey="Arians, Nathalie" sort="Arians, Nathalie" uniqKey="Arians N" first="Nathalie" last="Arians">Nathalie Arians</name></region><name sortKey="Arians, Nathalie" sort="Arians, Nathalie" uniqKey="Arians N" first="Nathalie" last="Arians">Nathalie Arians</name><name sortKey="Debus, Jurgen" sort="Debus, Jurgen" uniqKey="Debus J" first="Jürgen" last="Debus">Jürgen Debus</name><name sortKey="Debus, Jurgen" sort="Debus, Jurgen" uniqKey="Debus J" first="Jürgen" last="Debus">Jürgen Debus</name><name sortKey="Foerster, Robert" sort="Foerster, Robert" uniqKey="Foerster R" first="Robert" last="Foerster">Robert Foerster</name><name sortKey="Foerster, Robert" sort="Foerster, Robert" uniqKey="Foerster R" first="Robert" last="Foerster">Robert Foerster</name><name sortKey="Lindel, Katja" sort="Lindel, Katja" uniqKey="Lindel K" first="Katja" last="Lindel">Katja Lindel</name><name sortKey="Lindel, Katja" sort="Lindel, Katja" uniqKey="Lindel K" first="Katja" last="Lindel">Katja Lindel</name><name sortKey="Roeder, Falk" sort="Roeder, Falk" uniqKey="Roeder F" first="Falk" last="Roeder">Falk Roeder</name><name sortKey="Roeder, Falk" sort="Roeder, Falk" uniqKey="Roeder F" first="Falk" last="Roeder">Falk Roeder</name><name sortKey="Rom, Joachim" sort="Rom, Joachim" uniqKey="Rom J" first="Joachim" last="Rom">Joachim Rom</name><name sortKey="Uhl, Matthias" sort="Uhl, Matthias" uniqKey="Uhl M" first="Matthias" last="Uhl">Matthias Uhl</name><name sortKey="Uhl, Matthias" sort="Uhl, Matthias" uniqKey="Uhl M" first="Matthias" last="Uhl">Matthias Uhl</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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