Background: Intraoperative radiation therapy (IORT) is the delivery of a single large dose of radiation to a limited volume of tissue at the time of surgery. The aim of this study is to assess outcomes in patients who underwent IORT for gynecologic malignancies and to identify parameters that can predict a good outcome.Methods: This is a retrospective single-center cohort study including all women treated with surgery and IORT for a primary or recurrent gynecologic cancer between 2014 and 2022 at the Bern University Hospital, Switzerland.Results: A total of 30 patients with gynecologic malignancies were treated with surgery and IORT. Of these patients, 63.3% presented with cervical cancer, 23.3% with sarcoma, 10% with endometrial cancer, and 3.3% with carcinosarcoma of the ovary. Seventy percent (21/30) of women had an ECOG performance status of 0 at time of IORT. There was no difference in survival among women with incomplete surgical resection (R1/2 vs. R0) at time of IORT. Fifty percent of patients suffered postoperative complication of Clavien-Dindo grade >III, but there was no significant correlation of these complications to overall survival (p= 0.58). Three-year disease-free survival was 53.3%, and five-year overall survival was 53.3%. ECOG status was a significant parameter in DSS (p= 0.002) and OS (p= 0.02).Conclusion: Surgery with IORT is potentially a good treatment option in selected patients with recurrent or locally advanced cervical or endometrial cancer. An ECOG status of 0 is a significant parameter for good outcomes and should be taken into consideration for treatment decisions.
背景：术中放疗（IORT）是在手术期间对有限体积的组织进行单次大剂量放射治疗。本研究旨在评估接受IORT治疗的妇科恶性肿瘤患者的预后，并确定能够预测良好预后的参数。 方法：这是一项回顾性单中心队列研究，纳入了2014年至2022年间在瑞士伯尔尼大学医院接受手术联合IORT治疗的原发性或复发性妇科癌症的所有女性患者。 结果：共有30例妇科恶性肿瘤患者接受了手术联合IORT治疗。其中，63.3%为宫颈癌，23.3%为肉瘤，10%为子宫内膜癌，3.3%为卵巢癌肉瘤。70%（21/30）的女性在IORT时的ECOG体能状态评分为0。在IORT时，手术切除不完全（R1/2）与完全切除（R0）的女性患者生存率无差异。50%的患者出现了Clavien-Dindo分级>III级的术后并发症，但这些并发症与总生存率无显著相关性（p=0.58）。三年无病生存率为53.3%，五年总生存率为53.3%。ECOG状态是疾病特异性生存率（p=0.002）和总生存率（p=0.02）的显著预测参数。 结论：对于经过选择的复发性或局部晚期宫颈癌或子宫内膜癌患者，手术联合IORT可能是一种良好的治疗选择。ECOG状态为0是良好预后的重要参数，应在治疗决策中予以考虑。
Intraoperative Radiation Therapy for Gynecologic Malignancies: When Is It Indicated?
肿瘤(癌症)患者之家