Combined operative and radiotherapeutic treatment for locally recurrent gynaecologic cancer with pelvic wall invasion: A monocentric retrospective study
Managing locally recurrent gynecologic cancer with pelvic wall invasion, particularly after prior pelvic radiotherapy, presents a significant clinical challenge. Combined operative and radiotherapeutic treatment (CORT) is a potential curative approach. This study aims to evaluate the effectiveness and morbidity of this technique in this patient population as implemented within a single institution. A comprehensive, retrospective analysis was conducted on patients treated with CORT for recurrent gynecologic cancer with pelvic wall invasion after prior pelvic radiotherapy at the University Hospitals of Leuven between January 2000 and December 2023. A total of 21 patients were eligible for analysis. All patients underwent open surgical macroscopic tumor resection with intraoperative implantation of brachytherapy guiding tubes. The average radiation dose to 90% of the treatment volume (D90) was 45.6 Gy EQD2 (range 16.0 to 66.2 Gy). The median follow-up period was 37.8 months (range 3-230 months). Local control at 2 and 5 years was 87,4% and 77,8%; overall-survival at 2 and 5 years was 57,1% and 52,4%, respectively. Seventeen of the 21 patients experienced some form of adverse event, with 15 patients needing surgical re-intervention. Our retrospective analysis demonstrates high local control and favorable overall-survival outcomes in patients with recurrent gynecologic cancer involving the pelvic wall. However, the treatment is associated with a substantial risk of severe adverse events. Given the complexity and potential morbidity of this approach, CORT should be performed in specialized centers with experience in managing such cases.
