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• W2050330502 abstract "For patients with recurrent gynecologic malignancies in previously irradiated fields who are not candidates for radical curative-intent resections, few durable palliative treatment options exist. For local control of low volume, recurrent disease accessible by pelvic examination, we have used permanent 198Au interstitial reirradiation (198Au-IRI). In this analysis, we reviewed our institutional experience with this technique. Between 1994 and 2006, 19 patients were treated with 198Au-IRI for recurrent gynecologic malignancies after prior pelvic radiotherapy. All patients had small volume, biopsy-proven recurrent disease that was visible upon pelvic examination. No patient had disease thicker than 1 cm. All patients had no evidence of regional or distant disease by diagnostic imaging at the time of 198Au-IRI. All implants were pre-planned based on Paterson-Parker tables for planar implants. Seeds were inserted interstitially one at a time to depths of 0.3–0.5 cm. After implantation, orthogonal radiographs were obtained for placement verification and post-implant dosimetry. Doses were calculated based on the isodose line encompassing the tumor volume with 0.5 cm margin. All implants were performed under local anesthesia on an outpatient basis with exposure monitored during and after the procedure. Median age at treatment was 76 years (range 38–87). Median tumor volume was 3.3 cm3 (range 0.8–21.3). Median previous radiation dose from all radiation modalities was 67 Gy (range 38.7–91.6). Sites of primary disease included cervix (6), uterus (5), vagina (4), vulva (3), and urethra (1). Sites of recurrence included vagina (15), cervix (3), and vulva (1). Histologies included squamous cell carcinoma (11), adenocarcinoma (5), melanoma (2), and adenosarcoma (1). Median prescribed dose for 198Au-IRI was 50 Gy (range 25–55). A median of 12 198Au seeds (range 6–55) was implanted, with a median activity of 2.04 mCi/seed (range 1.0–3.38). With a median follow-up of 21 months (range 5–104), complete responses were obtained in 94.7% of patients, with local control being achieved after 198Au-IRI alone in 63.1% of patients. For the 7 patients who failed locally after 198Au-IRI, median disease-free interval post-198Au-IRI was 10 months (range 0–30). Six patients received further local therapy, including surgery (5) and repeat IRI using other isotopes (2), resulting in ultimate local control in 78.9% of all patients. At the time of analysis, 52.6% of patients were alive with no evidence of disease (NED). Treatment related toxicity was minimal, with grade III-IV acute or late toxicities limited to one grade III acute vaginal mucositis (5.3%). 198Au-IRI is a simple, well tolerated, minimally invasive, and reasonably efficacious method for controlling low-volume, recurrent gynecological malignancies in previously irradiated fields accessible by pelvic examination. In this setting, it represents a durable palliative option for women who are not candidates for radical curative-intent resections." @default.
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• W2050330502 date "2007-11-01" @default.
• W2050330502 modified "2023-09-26" @default.
• W2050330502 title "Permanent Interstitial Reirradiation with 198Au for Recurrent Gynecologic Malignancies" @default.
• W2050330502 doi "https://doi.org/10.1016/j.ijrobp.2007.07.1843" @default.
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