Permanent interstitial reirradiation with 198Au as salvage therapy for low volume recurrent gynecologic malignancies:...

To examine the Indiana University experience using 198Au permanent interstitial reirradiation (198Au-IRI) in the treatment of selected patients with recurrent gynecologic malignancies.

A retrospective review of 19 patients with recurrent gynecologic malignancies treated with 198Au-IRI between 1994 and 2006 was performed to evaluate disease response, local control, disease-free survival, overall survival, and toxicity.

All patients had no evidence of regional or distant metastatic disease at the time of treatment. 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). Median prescribed dose was 50 Gy (range, 25-55). With a median follow-up of 21 months, complete responses were obtained in 94.7% of patients, with local control being achieved after 198Au-IRI in 63.1% of patients. Including further salvage therapy, local control was ultimately achieved in 78.9% of patients. At the time of the analysis, 52.6% of patients were alive with no evidence of disease. Treatment-related toxicity was limited, with only 1 grade III toxicity (5.3%).

198Au-IRI is a safe, cost-effective, and reasonably efficacious method for controlling locally recurrent, low-volume, well-selected gynecologic malignancies, and treated with previous full-dose radiotherapy. It represents a reasonable potential therapeutic option in the salvage setting in patients who meet these criteria, particularly in women who are not candidates for or are unwilling to undergo radical salvage surgery.