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Introduction: Intraoperative radiation therapy (IORT) has been shown to provide effective local control (LC) for patients with unresectable and recurrent tumors. Here we present our experience with IORT during GU surgery.
Methods:
Since 2006, a multidisciplinary team at our institution has utilized a systematic approach to safely administer IORT. Case selection for IORT includes those in which: 1) preoperative radiation cannot obtain local control (LC) without excessive toxicity and 2) preoperative imaging suggests difficulty obtaining negative surgical margins due to proximity to vital structures, bladder, or bowel.
Results
Of 125 patients who underwent IORT from November 2006 to June 2014, 61 (49%) required urological surgery and thus composed our study cohort. Of these cases, 40 (66%) were for treatment of sarcoma (10 of primary GU origin), 13 (21%) for colorectal carcinoma, and 8 (13%) for varying gynecologic or anal malignancies. Mean IORT dose administered was 11.8Gy. Patients underwent radical cystectomy with urinary diversion in 44% of cases, radical nephrectomy in 34%, partial cystectomy in 8%, or another GU resection/mobilization in 13%. Positive margins occured in 27 (44%) cases. Of 37 (61%) patients with a Clavien 1-5 complication, wound infection (43%), gastrointestinal complication (21%), and neuropathy (13%) were most common. Thusfar, there have been no fistulas, breakdown of anastomoses (either bowel or ureteral) or delayed ureteral injury with IORT. With median follow up of 13 months, 2yr survival is 65%.
Conclusion
IORT is a safe and feasible treatment for high-risk patients undergoing complex surgery for sarcoma and other soft tissue malignancies.