Clinical management of pelvic relapses from gynecologic malignancies remains challenging. Bulky pelvic relapses often lead to symptomatic cancer-related complications and poor clinical outcomes. Options may be limited by prior surgical, chemotherapeutic, and radiation treatment. Stereotactic body radiosurgery is a novel treatment modality which allows high radiation dose delivery in a non-coplanar fashion with sub-millimeter precision utilizing a linear accelerator mounted on a robotic arm. This study details our clinical experience with stereotactic body radiosurgery for treatment of patients with pelvic relapses of gynecologic malignancies after prior pelvic radiation.
WylieJ.IrwinC.PintilieM.Results of radical radiotherapy for recurrent endometrial cancer. Gynecol Oncol77, 66–72 (2000).
2.
Jereczek-FossaB.BadzioA.JassemJ.Recurrent endometrial cancer after surgery alone: Results of salvage radiotherapy. Int J Radiat Oncol Biol Phys48, 405–413 (2000).
3.
CurranW. J.WhittingtonR.PetersA. J.Vaginal recurrences of endometrial carcinoma: The prognostic value of staging by a primary vaginal carcinoma system. Int J Radiat Oncol Biol Phys15, 803–808 (1998).
4.
PensonR. T.WenzelL. B.VergoteI.CellaD.Quality of life considerations in gynecologic cancer. FIGO 6th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet95, S247–S257 (2006).
5.
AckermanI.MaloneS.ThomasG.Endometrial carcinoma-relative effectiveness of adjuvant irradiation vs therapy reserved for relapse. Gynecol Oncol60, 177–183 (1996).
6.
CreutzbergC. L.van PuttenW. L. J.KoperP. C.For the PORTEC Study Group: Survival after relapse in patients with endometrial cancer. Results from a Randomized Trial. Gynecol Oncol89, 201–209 (2003).
7.
ThigpenJ. T.BuschbaumH. J.ManganC.Phase II trial of adriamycin in the treatment of advanced or recurrent endometrial carcinoma: A Gynecologic Oncology Group study. Cancer Treat Rep63, 21–27 (1979).
8.
JhingranA.BurkeT. W.EifelP. J.Definitive radiotherapy for patients with isolated vaginal recurrence of endometrial carcinoma after hysterectomy. Int J Radiat Oncology Biol Phys56, 1366–1372 (2003).
9.
DeppeG.CohenC. J.BrucknerH. W.Treatment of advanced endometrial adenocarcinoma with cis-dichlorodiammine platinum (II) after intensive prior therapy. Gynecol Oncol10, 51–54 (1980).
10.
RutledgeF. N.SmithJ. P.WhartonJ. T.O'QuinnA. G.Pelvic exenteration: Analysis of 296 patients. Am J Obstet Gynecol129, 881–892 (1977).
11.
SymmondsR. E.PrattJ. H.WebbM. J.Exenterative operations: Experience with 198 patients. Am J Obstet Gynecol121, 907–918 (1975).
WoodhouseC. R.PlailR. O.SchlesingerP. E.Exenteration as palliation for patients with advanced pelvic malignancy. Br J Urol76, 315–320 (1995).
14.
MarnitzS.KöhlerC.MüllerM.Indications for primary and secondary exenterations in patients with cervical cancer. Gynecol Oncol103, 1023–1030 (2006).
15.
Terán-PorcayoM. A.Zeichner-GanczI.del-CastilloR. A.Pelvic exenteration for recurrent or persistent cervical cancer: Experience of five years at the National Cancer Institute in Mexico. Med Oncol23, 219–223 (2006).
16.
RussellA. H.KohW. J.MarketteK.Radical reirradiation for recurrent or second primary carcinoma of the female reproductive tract. Gynecol Oncol27, 226–232 (1987).
17.
RandallM. E.EvansL.GrevenK. M.Interstitial reirradiation for recurrent gynecologic malignancies: Results and analysis of prognostic factors. Gynecol Oncol48, 23–31 (1993).
18.
MohiuddinM.MarksG.MarksJ.Long-term results of reirradiation for patients with recurrent rectal carcinoma. Cancer95, 1144–1150 (2002).
19.
LingareddyV.AhmadN. R.MohiuddinM.Palliative reirradiation for recurrent rectal cancer. Int J Radiat Oncol Biol Phys38, 785–790 (1997).
20.
HöckelM.KnapsteinP. G.KutznerJ.A novel combined operative and radiotherapeutic treatment approach for recurrent gynecologic malignant lesions infiltrating the pelvic wall. Surg Gynecol Obstet173, 297–302 (1991).
21.
AdlerJ. J.ChangS.MurphyM.The CyberKnife: A frameless robotic system for radiosurgery. Stereotact Funct Neurosurg69, 124–128 (1997).
22.
KuoJ.YuC.PetrovichZ.ApuzzoM.The CyberKnife stereotactic radiosurgery system: Description, installation, and initial evaluation of use and functionality. Neurosurgery53, 1235–1239 (2003).
23.
YuC.MainW.TaylorD.An anthropomorphic phantom study of the accuracy of CyberKnife spinal radiosurgery. Neurosurgery55, 1138–1149 (2004).
24.
EmamiB.LymanJ.BrownA.Tolerance of normal tissue to therapeutic radiation. Int J Radiat Oncol Biol Phys21, 109–122 (1991).
25.
TimmermanR. D.KavanaghB. D.ChoL. C.Stereotactic body radiation therapy in multiple organ sites. J Clin Oncol25, 947–952 (2007).
26.
PapiezL.TimmermanR.Hypofractionation in radiation therapy and its impact. Med Phys35, 112–118 (2008).
27.
ParkC.PapiezL.ZhangS.Universal survival curve and single fraction equivalent dose: Useful tools in understanding potency of ablative radiotherapy. Int J Radiat Oncol Biol Phys70, 847–852 (2008).
28.
HallE. J.GiacciaA. J.Radiobiology for the Radiologist.6th ed.Philadelphia, Lippincott, 2006. pp 391.
29.
BurmanC.KutcherG. J.EmamiB.GoiteinM.Fitting of normal tissue tolerance data to an analytic function. Int J Radiat Oncol Biol Phys21, 123–135 (1991).
30.
TrottiA.ColevasA. D.SetserA.CTCAE v3.0: Development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol13, 176–181 (2003).
31.
ZagarT. M.ShenkR. R.KimJ. A.HarppD.KunosC. A.Abdul-KarimF. W.ChenW. C.SeoY.KinsellaT. J.Radiation therapy in addition to gross total resection of retroperitoneal sarcoma results in prolonged survival: Results from a single institutional study. J Oncol2008, 824036 (2008).
32.
IjazT.EifelP. J.BurkeT.OswoldM. J.Radiation therapy of pelvic recurrence after adical hysterectomy for cervical carcinoma. Gynecol Oncol70, 241–246 (1998).
33.
MonkB. J.HuangH. Q.CellaD.LongH. J.3rd. Quality of life outcomes from a randomized phase III trial of cisplatin with or without topotecan in advanced carcinoma of the cervix: A Gynecologic Oncology Group Study. J Clin Oncol23, 4617–4625 (2005).
34.
PenalverM. A.BarreauG.SevinB. U.AveretteH. E.Surgery for the treatment of locally recurrent disease. J Natl Cancer Inst Monogr21, 117–122 (1996).
35.
ChiD. S.GemignaniM. L.CurtinJ. P.HoskinsW. J.Long-term experience in the surgical management of cancer of the uterine cervix. Semin Surg Oncol17, 161–167 (1999).
36.
KunosC.von GruenigenV.WaggonerS.Cyberknife radiosurgery for squamous cell carcinoma of vulva after prior pelvic radiation therapy. Technol Cancer Res Treat7, 375–380 (2008).
37.
LancianoR. M.MartzK.MontanaG. S.Influence of age, prior abdominal surgery, fraction size, and dose on complications after radiation therapy for squamous cell cancer of the uterine cervix. Cancer69, 2124 (1992).
38.
CreutzbergC. L.van PuttenW. L.KoperP. C.The morbidity of treatment for patients with Stage I endometrial cancer: Results from a randomized trial. Int J Radiat Oncol Biol Phys51, 1246–1255 (2001).
39.
KunosC.WaggonerS.Principle of radiation therapy and chemotherapy in gynecologic cancer: Basic principles, uses, and complications. In: Comprehensive Gynecology, 5th Ed, pp. 711–730. Eds., KatzV.LentzG.LoboR.GershensonD.Philadelphia, PA: Mosby (2007).
