Treatment of recurrent gynecologic malignancies with iodine-125 permanent interstitial irradiation

Purpose: To analyze the outcome of permanent I-125 interstitial radiotherapy for unresectable retroperitoneal recurrences of gynecologic malignancies. Methods and Materials: A retrospective review of 20 patients treated between 1979 and 1993 was performed to evaluate survival and morbidity associated with the interstitial I-125 technique. Results: Nineteen tumors were located on the lateral pelvic wall and one in the para-aortic region. Eight patients, not previously irradiated, received external beam radiotherapy (EBRT) along with I-125 interstitial implants placed at the time of celiotomy. Nineteen (95%) are dead of disease at 1-69 months of follow-up. The median survival was 7.7 months for patients treated with I-125 alone and 25.4 months for those treated with both I-125 and EBRT. One patient is alive without evidence of disease 69 months after I-125 implantation. Fistulas, bowel obstructions, and fatal complications occurred only among patients previously irradiated. Conclusions: When used in a previously irradiated field, I-125 interstitial radiotherapy has major morbidity and is unlikely to be associated with cure or long-term survival. In radiotherapy-naive patients with unresectable isolated recurrent gynecologic malignancies, I-125 implants and EBRT are feasible and occasionally may contribute to long-term disease-free survival. (C) 2002 Elsevier Science Inc.