Objective: We aimed to analyze the current literature for IORT in gynecological cancers and summarized clinical outcomes regarding patient selection. Methods: A systematic search was conducted utilizing PUBMED, Embase, and CINAHL to identify studies following PRISMA-ScR guidelines. A PICOS structure was utilized: population: patients with epithelial gynecological cancers; intervention: IORT; C: a comparator was not required, as we aimed to analyze patient selection; outcome: clinical outcomes and overall survival; and S: experimental and quasi-experimental analytical observational studies and descriptive observational studies, excluding case series published in English and limited to the last 10 years. Data extraction was conducted for patient selection, IORT, oncological outcomes, and morbidity. Results: A total of 707 results were identified, and 509 studies were uploaded to Covidence for screening after removing duplications. Of the 21 eligible studies, 9 were included in the final review. The total number of patients included was 348. The studies were retrospective single-institution studies, except for one. There was significant heterogeneity in their design and protocols. IORT was exclusively used for recurrent and advanced stage gynecological cancers adjunct to pelvic exenteration or laterally extended endopelvic resections with variable indications across institutions. The mean number of IORT patients per study was 2.8 per year. Survival rates were variable and dependent on the surgical margin. Endometrial cancer had a favorable outcome compared to vulvar and cervical cancers. Conclusions: Current clinical practice, as demonstrated by the research, is consistent with NCCN guidelines that endorse the application of IORT in instances of recurrent cervical, vaginal, and vulvar malignancies; however, there are no established recommendations for primary tumors. The analysis shows that there are gaps in our knowledge, mainly regarding the status of the margins, the criteria used to choose patients, and the outcomes that are specific to each histology. The standardization of protocols and prospectively powered studies are needed to refine patient selection criteria.
目的：本研究旨在分析妇科肿瘤术中放疗的现有文献，并总结患者选择相关的临床结局。方法：遵循PRISMA-ScR指南，通过PUBMED、Embase和CINAHL数据库进行系统性文献检索。采用PICOS框架：研究对象为上皮性妇科肿瘤患者；干预措施为术中放疗；因本研究聚焦患者选择分析，故不设对照组；结局指标包括临床结局与总生存期；研究类型限定为近10年发表的实验性、准实验性分析观察研究及描述性观察研究，排除英文病例系列报告。数据提取涵盖患者选择标准、术中放疗方案、肿瘤学结局及并发症。结果：初筛获得707篇文献，剔除重复后509篇进入Covidence平台筛选。最终纳入符合标准的21项研究中的9篇进行系统评价，共包含348例患者。除一项研究外，其余均为单机构回顾性研究，研究设计与方案存在显著异质性。术中放疗均作为盆腔廓清术或侧向扩展盆腔内切除术的辅助治疗，专门用于复发性和晚期妇科肿瘤，但各机构的适应证选择存在差异。各研究中年均术中放疗患者数为2.8例。生存率存在差异且与手术切缘状态相关，子宫内膜癌预后优于外阴癌和宫颈癌。结论：现有研究表明，当前临床实践与美国国家综合癌症网络指南一致，支持术中放疗应用于复发性宫颈癌、阴道癌及外阴癌，但对原发性肿瘤尚无明确推荐。分析显示现有知识存在空白，主要体现在切缘状态评估、患者选择标准及组织学特异性结局方面。未来需通过方案标准化和前瞻性研究完善患者选择标准。
Intraoperative Radiation Therapy (IORT) in Gynecologic Cancers: A Scoping Review
肿瘤(癌症)患者之家