Repeated Irradiation of the Pelvis in Patients withGynaecological Malignities - Asset vs. Risk

Overview

Objective:
To evaluate the results of repeated radiotherapy in the pelvis region in patients withgynaecological cancer.Design: Retrospective analysis of overall survival, degree and duration of palliation as well asassessment of the toxicity profile of treatment. The authors compared their own results with datain the relevant literature.Setting: Radiotherapy and Oncology Department, Faculty Hospital Královské Vinohrady, Prague,Czech Republic.Methods: From all files of patients with carcinoma of the gynaecological tract treated in thedepartment after the introduction of megavoltage radiotherapy those with reirradiation of atleast 60 Gy in the pelvis region were reviewed. Overall survival, the extent and duration of thesubjective relief, resolution of the pressure symptoms, acute and chronic treatment toxicity wereanalysed with respect to the anticipated predicators.Results: 21 patients were analysed. In 7/21 (33%) the symptoms (pain, bleeding, discharge, com-pression of the neighbouring structures) have been completely (temporarily or indefinitely) resol-ved. In 6/21 (29%) the effect was partial. The palliation lasted for 9-101 months (median 5 months).Statistically significant correlation was found between the palliative effect and better performan-ce status. A trend which, however, did not reach statistical significance was found between betterpalliation and biologically equivalent dose of the second radiotherapy course and/or applicationof concomitant radiochemotherapy. The toxicity of treatment was relatively mild.Conclusion: Second course of radiotherapy is an effective treatment modality in patients withpersistent or recurrent gynaecological malignancies. If carefully indicated and performed, thetoxicity is relatively very acceptable. Reirradiation is not recommended in patients with a veryshort prognosis due to advanced disease or poor general condition. Concomitant chemoradiothe-rapy can improve therapeutic ratio.

Key words:
reiradiation, overall survival, acute and chronic treatment toxicity