Intraoperative Brachytherapy (Hdr-Iobt) In Advanced Or Recurrence Gynecologic Cancer: An Effective Alternative In Tumors Of Poor Prognosis

Introduction/Background The aim of this study is to review our initial results in the treatment with surgery and Intraoperative Brachytherapy (HDR-IOBT) in advanced or recurrence gynecologic cancer. Methodology We included two patient groups: Group 1: advanced cervical cancer with poor response to Radiation and chemotherapy; group 2: pelvic recurrence of gynecological tumors of any origin. In all CT and MRI was performed, in recurrences also PET. The surgical procedure depended on the extent of disease with pelvic exenteration, enlarged cystectomy and/or rectal resection. Surgical specimen was confirmed in all cases with intraoperative biopsy to ensure the absence of macroscopic residual disease. We put clips in the surgical bed. Subsequently the applicator Fleipbrup was placed according to the extension of the bed. After intraoperative planning, a dose of 10 Gy prescribed at 0.5 cm bed depth was administered. Finally, the applicator was removed to complete the surgery. Results Between October 2011 and December 2018, 29 patients have been included. In group 1, there were 14 patients with cervical cancer stage IIB in 9 p and IIIB in 6; in group 2 were 15 recurrences. With a median follow-up of 35 months, the Local DFS 3 years was 59.3% Group 1: 74.5%; Group 2: 41.34%; 3 years Overall Survival 63.3%: Group 1: 70.3%, Group 2: 54%. The complications were fistula 5p (17.2%): 1 intestinal, 4 bladder, sigmoid stenosis 2p (6.8%), osteitis pubis in 1p (3.4%). Ureteral stenosis 5p (17.1%). Conclusion HDR-IOBT associated with pelvic exenteration offers good results of pelvic control and overall survival in patients with gynecologic cancer with a poor prognosis. However the number of complications, especially fistulas has been important, so we must take it into account for prevention. These results are possible thanks to the multidisciplinary approach to these patients. Disclosure Nothing to disclose.