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922 Intraoperative radiation therapy for gynaecologic malignancies: what can we expect? When is it indicated?
  1. Flavia Pagano,
  2. Flurina Anna-Carina Saner,
  3. Michael David Mueller,
  4. Codruta Ionescu,
  5. Kristina Loessl and
  6. Sara Imboden
  1. Inselspital, Bern, Switzerland


Introduction/Background Intraoperative radiation therapy (IORT) is the delivery of a single large dose of radiation to a limited volume of tissue at the time of surgery. It can been used in the primary management as well as in the salvage setting in patients with a solid tumor and an isolated locoregional recurrence.

Methodology This is a retrospective cohort study including all women treated with surgery and IORT for a primary or recurrent gynaecological cancer between 2014 – 2022 at the University Hospital Bern. We analyzed patient, tumor and operative characteristics to evaluate the oncological outcome.

Results During the study period, 30 women were treated for four different pelvic malignancies: cervical cancer (n= 19, 63.3%), sarcoma (n= 7, 23.3%), endometrial cancer (n= 3, 10%) and carcinosarcoma of the ovary (n=1 3.3%). The majority had an advanced FIGO stage III/IV (86.7%) at time of IORT, and 80% were treated with IORT for a recurrence. Median interval between primary treatment and IORT for a relapse was 38.2 months. 70% (21/30) of women had an ECOG performance status 0 at time of IORT. There was no difference in survival among women with different tumor types. Half of all women had a postoperative complication of Clavien Dindo grade >III showing the high morbidity of these surgeries, however there is no significant correlation of these complications to overall survival (p=0.66). Two-year disease-free survival (DFS) was 18.2% and overall survival (OS) 58.1%.

Conclusion Our experience suggest that IORT may benefit patients with locally advanced or locally recurrent cervical or endometrial cancer with an ECOG 0 have best prognosis. No parameters were detected that could reduce the complication rates, however nether severe complications nor unclean Resection margins have an negative impact on oncological outcome. The role of IORT in the treatment of advanced primary and recurrent gynecologic cancers stays an individual decision.

Disclosures All the authors have declared no conflicts of interest.

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