Andrea Bertram McKee MD, Presenter: Nothing to Disclose

Luc M. Sirois MSc, Abstract Co-Author: Nothing to Disclose

Anne P. Shapter MD, Abstract Co-Author: Nothing to Disclose

Brian Knab MD, Abstract Co-Author: Nothing to Disclose

Brady John McKee MD, Abstract Co-Author: Nothing to Disclose

Sebastian Flacke MD, Abstract Co-Author: Nothing to Disclose

Arul Mahadevan MD, Abstract Co-Author: Nothing to Disclose

Purpose/Objective(s): Local recurrence of pelvic malignancies poses a significant therapeutic challenge. We report our experience treating isolated local recurrence of gynecologic malignancies with stereotactic body radiotherapy (SBRT). Material/Methods: We evaluated the outcome of 7 consecutive patients (mean age 70 y, range 56 - 80) presenting with locally recurrent endometrial (n=5) and cervical (n=2) cancer treated with SBRT. Three additional treated patients were excluded from analysis due to the presence of metastatic disease. Previous therapy consisted of hysterectomy (n=7), chemotherapy (n=2) and radiation with external beam (EBRT) (n=2) and/or brachytherapy (n=3). Mean time to recurrence was 3.7 y (range 1 - 13.5). Mean recurrent tumor size was 4.4 cm (range 1.5 - 9) with extension to both pelvic sidewalls in 4/7 (57%). Four fiducial markers or two coils were placed transvaginally under ultrasound guidance for subsequent stereotactic localization. MR/CT (n=7) and PET (n=2) fusion target delineation and treatment planning were performed with BrainLAB software following accepted HDR intracavitary DVH parameters for critical structures. Patients were treated every other day to 25-35 Gy (median dose 30 Gy) in 5 fractions using fiducial based daily ExacTrac localization and robotic 6-D couch positioning on a Novalis Body system (BrainLAB AG & Varian Medical Systems, Inc.). 2/7 (29%) received pelvic EBRT and 2/7 (29%) received chemotherapy in addition to SBRT. Patients were followed at 3 month intervals with pelvic exam, vaginal cytology and imaging. Treatment complications were graded via the Radiation Therapy Oncology Group (RTOG) scale. Results: At mean followup of 12 months (range 3.2 - 18.1) all patients were alive with complete tumor response based on clinical exam, imaging and cytology as well as histopathologic confirmation of tumor necrosis in 1 patient. One patient developed regional recurrence in pelvic lymph nodes outside the radiation field yielding a disease free survival of 86%. There was no acute treatment related morbidity. One patient with a history of previous brachytherapy and colonic diversion for recurrent diverticulitis redeveloped diverticulitis with colovaginal and colovesical fistulae 10 months following treatment resulting in diverting colostomy and urostomy. Despite pathologic confirmation of acute diverticulitis we could not exclude radiation as a contributing factor and scored this as an RTOG grade 4 complication. Conclusion: SBRT is a promising option for the treatment of isolated local recurrence of gynecologic malignancies. Our results suggest excellent local control with no acute toxicity even among previously irradiated women. Patients with multiple medical co-morbidities may have increased long-term risk associated with retreatment.

McKee, A, Sirois, L, Shapter, A, Knab, B, McKee, B, Flacke, S, Mahadevan, A, Salvage SBRT for Isolated Local Recurrence of Gynecologic Malignancies.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8500642.html