Background/Objectives: Our objective was to describe the use of intraoperative radiation therapy (IORT) for the treatment of recurrent/persistent cervical or endometrial cancer and assess predictors of postoperative complications and 3-year mortality. Methods: In this multi-site retrospective study, data were abstracted for recurrent/persistent endometrial or cervical cancer patients who underwent IORT from June 2004 to May 2021. Complications were graded on the six-point Accordion scale. Variables associated with complications were analyzed with univariate logistic regression, while variables associated with death within 3 years were analyzed with Cox proportional hazards modeling. Survival was analyzed with the Kaplan–Meier method. Results: Eighty patients had planned IORT for recurrent/persistent endometrial (n = 35) or cervical cancer (n = 45). The mean age of the cohort was 56.8 years (SD = 13.7), and the median disease-free interval from primary disease to recurrence was 20.0 months (IQR 10.0–63.1). The overall survival at 3 years was 48.6% (95% CI: 38.3–61.6%) with a median survival of 2.8 years. Within 30 days postoperative, 16 patients (20.1%) had grade 3–5 complications and one death (1.3%) occurred. Factors associated with grade 3+ complication included ECOG PS 2–3 (OR 18.00,p= 0.04), neoadjuvant chemotherapy and/or immunotherapy (OR 6.98,p< 0.01), and pelvic sidewall involvement (OR 8.80,p= 0.04). Factors associated with death within 3 years of surgery included ECOG PS 2–3 (HR 8.97,p< 0.01), neoadjuvant chemotherapy and/or immunotherapy (HR 2.34,p= 0.03), whether exenteration was performed (HR 2.64,p= 0.01), and positive resection margin (HR 3.37,p< 0.01). Conclusions: In well-selected patients, IORT is a feasible and safe option for the treatment of recurrent/persistent gynecologic malignancy with an appreciable survival benefit.
背景/目的：本研究旨在描述术中放射治疗（IORT）在复发/持续性宫颈癌或子宫内膜癌治疗中的应用情况，并评估术后并发症及3年死亡率的预测因素。方法：在这项多中心回顾性研究中，我们提取了2004年6月至2021年5月期间接受IORT治疗的复发/持续性子宫内膜癌或宫颈癌患者数据。并发症采用六点Accordion分级量表进行评估。通过单因素逻辑回归分析与并发症相关的变量，同时采用Cox比例风险模型分析与术后3年内死亡相关的变量。生存分析采用Kaplan-Meier法。结果：共80例复发/持续性子宫内膜癌（35例）或宫颈癌（45例）患者计划接受IORT治疗。队列平均年龄56.8岁（标准差=13.7），从原发疾病到复发的中位无病间隔期为20.0个月（四分位距10.0-63.1）。3年总生存率为48.6%（95%置信区间：38.3-61.6%），中位生存期2.8年。术后30天内，16例患者（20.1%）发生3-5级并发症，1例死亡（1.3%）。与3级及以上并发症相关的因素包括：ECOG体能状态评分2-3分（比值比18.00，p=0.04）、新辅助化疗和/或免疫治疗（比值比6.98，p<0.01）以及盆腔侧壁受累（比值比8.80，p=0.04）。与术后3年内死亡相关的因素包括：ECOG体能状态评分2-3分（风险比8.97，p<0.01）、新辅助化疗和/或免疫治疗（风险比2.34，p=0.03）、是否实施脏器切除术（风险比2.64，p=0.01）以及切缘阳性（风险比3.37，p<0.01）。结论：对于经过严格筛选的患者，IORT是治疗复发/持续性妇科恶性肿瘤可行且安全的选择，并能带来显著的生存获益。
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