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Intraoperative Radiation Therapy (IORT) in Gynecologic Cancers: A Scoping Review
Evrim Erdemoglu1,2, Stuart A Ostby3, Sanjanaa Senthilkumar4
1Department of Medical and Gynecologic Surgery, Mayo Clinic, Phoenix, AZ 85054, USA.
Cancers
|April 26, 2025
Summary
Intraoperative radiation therapy (IORT) is used for recurrent gynecological cancers, but patient selection criteria and outcomes need standardization. More research is required to optimize its use in treating these advanced malignancies.
Area of Science:
- Gynecologic Oncology
- Radiation Oncology
- Surgical Oncology
Background:
- Intraoperative radiation therapy (IORT) is an established technique in various cancer treatments.
- Its application in gynecological cancers, particularly for recurrent or advanced stages, warrants a comprehensive review of existing literature.
- Understanding current practices and outcomes is crucial for refining treatment strategies.
Purpose of the Study:
- To systematically analyze the existing literature on the use of IORT in gynecological cancers.
- To summarize clinical outcomes and evaluate patient selection criteria for IORT in this patient population.
- To identify gaps in knowledge and areas for future research.
Main Methods:
- A systematic literature search was performed using PUBMED, Embase, and CINAHL databases, adhering to PRISMA-ScR guidelines.
- Studies were selected based on a PICOS framework, focusing on patients with epithelial gynecological cancers undergoing IORT.
- Data extraction included patient selection, IORT details, oncological outcomes, and morbidity from eligible retrospective and quasi-experimental studies published within the last 10 years.
Main Results:
- Nine studies involving 348 patients were included, revealing significant heterogeneity in study design and IORT protocols.
- IORT was predominantly used for recurrent and advanced-stage gynecological cancers, often in conjunction with major surgical resections.
- Survival rates were variable and linked to surgical margins, with endometrial cancer showing better outcomes than vulvar and cervical cancers.
Conclusions:
- Current IORT use in gynecological oncology aligns with NCCN guidelines for recurrent cervical, vaginal, and vulvar cancers, but lacks recommendations for primary tumors.
- Significant knowledge gaps exist regarding margin status, patient selection criteria, and histology-specific outcomes.
- Standardized protocols and prospective studies are essential to refine patient selection and improve IORT efficacy in gynecological cancers.
