Organübergreifendes Debulking in Kombination mit intraoperativer Strahlentherapie (IORT) im multimodalen Therapiespektrum von Beckenrezidiven
| Autor: | Junkermann H, G. Bastert, I. J. Diel, Erich-Franz Solomayer, M. J. Eble, E.-M. Grischke, M. Wannenmacher, T. Schönig, Manfred Kaufmann, D. Wallwiener |
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| Rok vydání: | 1998 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment Brachytherapy Obstetrics and Gynecology Perioperative Pelvic cavity medicine.disease Surgery Metastasis Radiation therapy Tumor Debulking medicine.anatomical_structure Maternity and Midwifery medicine Carcinoma business Complication |
| Zdroj: | Geburtshilfe und Frauenheilkunde. 58:19-26 |
| ISSN: | 1438-8804 0016-5751 |
| Popis: | In patients with pelvic recurrences the therapeutic dilemma resides in the fact that despite radical tumor debulking tumor control can rarely be achieved. The impact of tumor debulking combined with IORT on local tumor control and overall survival was evaluated in patients with advanced disease. Patients and Methods: Between Januar 1992 and August 1995, 28 patients with pelvic recurrences were selected for tumor debulking plus IORT. Due to intraperitoneal metastases 9 patients had no IORT. Multi-organ resection was performed in 8 of 19 patients treated with tumor debulking plus IORT. In previously irradiated women (n =10) an IORT dose of 18 Gy, and in patients without prior irradiation 15 Gy plus 40 Gy external beam irradiation was given. Results: After a median follow-up of 26 months a significant difference (p = 0.032) was observed between those patients with (med. OAS 8 months) and without prior irradiation (med. OAS 16 months). Median OAS was 9 months in patients after complete resection (n=3), and 6.5 months after non-complete resection (p = 0.003). There were only two recurrences in the irradiation field. No perioperative complications were observed. One neuropathy (sensitive) occurred after 6 months. Conclusions: Using multi-modality approaches in pretreated patients with pelvic recurrences an good local tumor control could be achieved without increased mortality and morbidity. However, answers to a number of open questions are still lacking, such as the tolerance of healthy tissue to high doses of external irradiation with or without brachytherapy as boost technique, or questions related to the optimisation of individual selection criteria, resp. to the possible integration of IORT into the therapeutic concept of primary advanced gynecologic malignancies. Further optimisation of multi-modality treatment with maximal interdisciplinary effort will be essential. |
| Databáze: | OpenAIRE |
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