Intraoperative radiation therapy in the management of gynecologic and genitourinary XXXX .

@entity1 @entity66 @entity5 @entity1358 @entity150
@entity1 with locally advanced primary or recurrent @entity5 have a poor prognosis. The doses of external radiation necessary to treat gross or microscopic recurrent disease in @entity1 previously irradiated exceed the doses tolerated by normal tissue [1,3-5]. IORT has been added to the treatment armamentarium in this group of @entity1 to maximize local control and minimize the radiation exposure to dose-limiting surrounding structures. In addition, IORT may improve the long-term local control and the overall survival rates in @entity1 with pelvic sidewall or para-aortic nodal recurrence [1,4,5]. The most encouraging results are seen in cases of microscopic @entity66 following surgical debulking [4,6]. In @entity5 , IORT has served to reiterate the importance of optimal surgical resection. Higher 5-year disease-free and overall survival rates have been documented in @entity1 who have microscopic @entity66 , compared with those who have gross @entity66 [1,3-6]. IORT in the management of @entity5 has not been used extensively. In @entity1358 , where surgery alone often results in suboptimal treatment results, IORT seems to be well tolerated and controls local disease [2,27,29,30]. Because of the chemoresistant nature of @entity1358 , IORT may play an important role in the future in the management of locally advanced and recurrent @entity1358 . In @entity150 , IORT had been used in combination with chemotherapy and EBRT, as part of bladder-sparing protocols. The data suggest that IORT in this @entity1 population is also well tolerated, and may become more widely used as less radical surgical procedures gain clinical importance. IORT in the treatment of prostate and @entity5 has not been used frequently, given the highly efficacious treatment modalities currently available to treat these @entity5 . A review of institutional experiences with IORT may allow the establishment of guidelines for @entity1 selection. These criteria, in turn, may be useful in the design of clinical trials. The construction, execution, and evaluation of clinical trials are mandatory to adequately assess the role of IORT in the treatment of @entity1 with gynecologic and @entity5 .
