Implementation and experiences of an intraoperative radiotherapy service

2006 ◽  
Vol 5 (4) ◽  
pp. 203-210 ◽  
Author(s):  
K. Armoogum ◽  
C. Ackland ◽  
J. Gardner
Keyword(s):  
Treatment Time ◽  
Early Stage ◽  
External Beam Radiotherapy ◽  
Intraoperative Radiotherapy ◽  
Successful Implementation ◽  
Nurse Specialist ◽  
Oncology Nurse ◽  
Spherical Volume ◽  
Medical Physicists ◽  
The Mean

Intraoperative radiotherapy (IORT) using a miniature X-ray source has the potential to impart the same clinical benefit as external beam radiotherapy (EBRT), in a single fraction. The patient benefits are significant, since IORT could replace several weeks of fractionated EBRT. We present our initial experiences of IORT using the Zeiss Intrabeam™ system for treating early stage breast cancer and intracranial malignancies. Implementing this treatment modality requires a multidisciplinary approach drawing on the expertise of surgeons, oncologists, medical physicists, anaesthesiologists, nursing staff and pathologists. Team coherence is facilitated by a nurse co-ordinator. We have treated 66 patients in 24 months. For breast tumours, the mean treatment time was 28.54 min and the applicator sizes ranged from 3.0 to 5.0cm (mode = 4.5cm). A dose of 5Gy is prescribed to spherical volume of 1cm from the applicator surface. For brain tumours, the mean treatment time was 19.70 min and the applicator sizes ranged from 1.5 to 3.5cm (mode = 2.5cm). Mean dose was 11.1Gy prescribed to a spherical volume of 0.5cm from the applicator surface.A multidisciplinary team is essential for the successful implementation of IORT. This paper describes how, through reliance on an oncology nurse specialist to co-ordinate the programme, we have successfully set-up an IORT service.

Accelerated Partial Breast Irradiation in Early-Stage Breast Cancer

2007 ◽  
Vol 25 (8) ◽  
pp. 996-1002 ◽  
Author(s):  
Mary Ella Sanders ◽  
Troy Scroggins ◽  
Federico L. Ampil ◽  
Benjamin D. Li
Keyword(s):  
Breast Cancer ◽  
Time Course ◽  
Treatment Time ◽  
Early Stage ◽  
Breast Conservation ◽  
Intraoperative Radiotherapy ◽  
Accelerated Partial Breast Irradiation ◽  
Intracavitary Brachytherapy ◽  
Partial Breast Irradiation ◽  
Breast Irradiation

Whole-breast irradiation, as part of breast-conservation therapy (BCT), has well-established results, good cosmesis, and low toxicity. Results from the BCT trials suggest that the risk for ipsilateral breast cancer recurrence resides within close proximity to the original tumor site. This leads investigators to consider the role of an accelerated and more tumor bed–focused course of radiotherapy. Accelerated partial-breast irradiation (APBI) involves treating a limited volume of breast tissue, with dose of irradiation per fraction increased and the treatment time course decreased. Four currently available methods of APBI are interstitial brachytherapy, intracavitary brachytherapy, intraoperative radiotherapy, and three-dimensional conformal external-beam radiotherapy. Patient selection is critical. This review article presents some preliminary clinical observations and limitations that suggest a potential role for APBI as a more user-friendly mode for delivering radiotherapy after lumpectomy for early breast cancer.

scholarly journals Intraoperative Radiotherapy for Breast Cancer: The Lasting Effects of a Fleeting Treatment

2014 ◽  
Vol 2014 ◽  
pp. 1-12 ◽  
Author(s):  
Harriet B. Eldredge-Hindy ◽  
Anne L. Rosenberg ◽  
Nicole L. Simone
Keyword(s):  
Breast Cancer ◽  
Patient Satisfaction ◽  
Early Stage ◽  
External Beam Radiotherapy ◽  
Breast Conservation ◽  
Intraoperative Radiotherapy ◽  
Ipsilateral Breast Tumor Recurrence ◽  
Partial Breast Irradiation ◽  
Breast Irradiation ◽  
Breast Radiotherapy

In well-selected patients who choose to pursue breast conservation therapy (BCT) for early-stage breast cancer, partial breast irradiation (PBI) delivered externally or intraoperatively, may be a viable alternative to conventional whole breast irradiation. Two large, contemporary randomized trials have demonstrated breast intraoperative radiotherapy (IORT) to be noninferior to whole breast external beam radiotherapy (EBRT) when assessing for ipsilateral breast tumor recurrence in select patients. Additionally, IORT and other PBI techniques are likely to be more widely adopted in the future because they improve patient convenience by offering an accelerated course of treatment. Coupled with these novel techniques for breast radiotherapy (RT) are distinct toxicity profiles and unique cosmetic alterations that differ from conventional breast EBRT and have the potential to impact disease surveillance and patient satisfaction. This paper will review the level-one evidence for treatment efficacy as well as important secondary endpoints like RT toxicity, breast cosmesis, quality of life, patient satisfaction, and surveillance mammography following BCT with IORT.

scholarly journals Dosimetric Comparison of Upfront Boosting With Stereotactic Radiosurgery Versus Intraoperative Radiotherapy for Glioblastoma

2021 ◽  
Vol 11 ◽  
Author(s):  
Gustavo R. Sarria ◽  
Zuzanna Smalec ◽  
Thomas Muedder ◽  
Jasmin A. Holz ◽  
Davide Scafa ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Organs At Risk ◽  
External Beam Radiotherapy ◽  
Intraoperative Radiotherapy ◽  
Target Volume ◽  
Maximum Diameter ◽  
Target Definition ◽  
Treatment Plans ◽  
Previously Treated Patients ◽  
The Mean

PurposeTo simulate and analyze the dosimetric differences of intraoperative radiotherapy (IORT) or pre-operative single-fraction stereotactic radiosurgery (SRS) in addition to post-operative external beam radiotherapy (EBRT) in Glioblastoma (GB).MethodsImaging series of previously treated patients with adjuvant radiochemotherapy were analyzed. For SRS target definition, pre-operative MRIs were co-registered to planning CT scans and a pre-operative T1-weighted gross target volume (GTV) plus a 2-mm planning target volume (PTV) were created. For IORT, a modified (m)GTV was expanded from the pre-operative volume, in order to mimic a round cavity as during IORT. Dose prescription was 20 Gy, homogeneously planned for SRS and calculated at the surface for IORT, to cover 99% and 90% of the volumes, respectively. For tumors > 2cm in maximum diameter, a 15 Gy dose was prescribed. Plan assessment was performed after calculating the 2-Gy equivalent doses (EQD2) for both boost modalities and including them into the EBRT plan. Main points of interest encompass differences in target coverage, brain volume receiving 12 Gy or more (V12), and doses to various organs-at-risk (OARs).ResultsSeventeen pre-delivered treatment plans were included in the study. The mean GTV was 21.72 cm3 (SD ± 19.36) and mGTV 29.64 cm3 (SD ± 25.64). The mean EBRT and SRS PTV were 254.09 (SD ± 80.0) and 36.20 cm3 (SD ± 31.48), respectively. Eight SRS plans were calculated to 15 Gy according to larger tumor sizes, while all IORT plans to 20 Gy. The mean EBRT D95 was 97.13% (SD ± 3.48) the SRS D99 99.91% (SD ± 0.35) and IORT D90 83.59% (SD ± 3.55). Accounting for only-boost approaches, the brain V12 was 49.68 cm3 (SD ± 26.70) and 16.94 cm3 (SD ± 13.33) (p<0.001) for SRS and IORT, respectively. After adding EBRT results respectively to SRS and IORT doses, significant lower doses were found in the latter for mean Dmax of chiasma (p=0.01), left optic nerve (p=0.023), right (p=0.008) and left retina (p<0.001). No significant differences were obtained for brainstem and cochleae.ConclusionDose escalation for Glioblastoma using IORT results in lower OAR exposure as conventional SRS.

Breast intraoperative radiotherapy: a review of available modalities, dedicated machines and treatment procedure

2018 ◽  
Vol 18 (1) ◽  
pp. 98-106 ◽  
Author(s):  
Hamid Reza Baghani ◽  
Hajar Moradmand ◽  
Seyed Mahmoud Reza Aghamiri
Keyword(s):  
Clinical Outcomes ◽  
Treatment Time ◽  
External Beam Radiotherapy ◽  
Intraoperative Radiotherapy ◽  
Reference List ◽  
Treatment Procedure ◽  
Dose Uniformity ◽  
Dedicated Machines ◽  
Treatment Procedures ◽  
Electron Radiotherapy

AbstractBackgroundBreast intraoperative radiotherapy (IORT) is a partial irradiation technique that delivers a single fraction of radiation dose to the tumour bed during surgery. The use of this technique is increasing (especially in the Middle East), and therefore, it is essential to have a comprehensive approach to this treatment modality. The aim of this study is to conduct a literature review on available IORT modalities during breast irradiation as well as dedicated IORT machines and associated treatment procedures. The main IORT trials and corresponding clinical outcomes are also studied.Materials and MethodsA computerised search was performed through MEDLINE, PubMed, PubMed Central, ISI web of knowledge and reference list of related articles.ResultsIORT is now feasible through using two main modalities, including low-kilovolt IORT and intraoperative electron radiotherapy (IOERT). The dedicated machines employed and treatment procedure for mentioned modalities are quite different. The outcomes of implemented clinical trials showed that IORT is not inferior to external beam radiotherapy (EBRT) in specifically selected and well-informed patients and can be considered as an alternative to EBRT.ConclusionAlthough the clinical outcomes of introduced IORT methods are comparable, but based on the review results, it could be said that IOERT is the most effective technical method, in view of the treatment time and dose uniformity concepts. The popularity of IORT is mainly due to the distinguished obtained results during breast cancer treatment. Despite the presence of some technical challenges, it is expected that the IORT technique will become more widespread in the immediate future.

scholarly journals Intraoperative radiotherapy with low energy x-rays after neurosurgical resection of brain metastases – Augsburg University Medical Center experience

2021 ◽  
Author(s):  
Klaus-Henning Kahl ◽  
Nikolaos Balagiannis ◽  
Michael Höck ◽  
Sabine Schill ◽  
Zoha Roushan ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Treatment Time ◽  
Medical Center ◽  
External Beam Radiotherapy ◽  
Intraoperative Radiotherapy ◽  
X Rays ◽  
Overall Treatment Time ◽  
X Ray ◽  
Resection Cavity ◽  
Brain Radiotherapy

Abstract Purpose External beam radiotherapy (EBRT) is the predominant method for localized brain radiotherapy (LBRT) after resection of brain metastases (BM). Intraoperative radiotherapy (IORT) with 50kV x-rays is an alternative way to irradiate the resection cavity focally after BM surgery with the option to shorten the overall treatment time and limit normal tissue irradiation.Methods We retrospectively analyzed the outcomes of all patients who underwent neurosurgical resection of BM and 50kV x-ray IORT between 2013 and 2020 at Augsburg University Medical Center.Results We identified 40 patients with 44 resected BM treated with 50kV x-ray IORT. Median diameter of the resected metastases was 2.8 cm (range 1.5–5.9 cm). Median applied dose was 20 Gy. All patients received standardized follow-up (FU) including 3-monthly MRI of the brain. Mean FU was 14.4 months, with a median MRI FU for patients alive of 12.2 months. Median overall survival (OS) of all treated patients was 26.4 months (estimated 1-year OS 61.6%). The observed local control (LC) rate of the resection cavity was 88.6% (estimated 1-year LC 84.3%). Distant brain control (DC) was 47.5% (estimated 1-year DC 33.5%). Only 25% of all patients needed WBI in the further course of disease. The observed radionecrosis rate was 2.5%.Conclusion IORT with 50kV x-rays is a safe and appealing way to apply LBRT after neurosurgical resection of BM with low toxicity and excellent LC. Close MRI FU is paramount to detect distant brain failure (DBF) early.

scholarly journals Intraoperative Radiotherapy Versus Whole-Breast External Beam Radiotherapy in Early-Stage Breast Cancer

Medicine ◽  
2015 ◽  
Vol 94 (27) ◽  
pp. e1143 ◽  
Author(s):  
Li Zhang ◽  
Zhirui Zhou ◽  
Xin Mei ◽  
Zhaozhi Yang ◽  
Jinli Ma ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
External Beam Radiotherapy ◽  
Intraoperative Radiotherapy ◽  
Early Stage Breast Cancer ◽  
External Beam

scholarly journals Mammographic Findings after Intraoperative Radiotherapy of the Breast

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Ronald Rivera ◽  
Virginia Smith-Bronstein ◽  
Sylvia Villegas-Mendez ◽  
Jessica Rayhanabad ◽  
Pulin Sheth ◽  
...  
Keyword(s):  
Early Stage ◽  
Mass Density ◽  
External Beam Radiotherapy ◽  
Intraoperative Radiotherapy ◽  
Cancer Recurrence ◽  
Cancer Control ◽  
Breast Conserving Therapy ◽  
Controlled Clinical Trial ◽  
Architectural Distortion ◽  
Fat Necrosis

Intraoperative Radiotherapy (IORT) is a form of accelerated partial breast radiation that has been shown to be equivalent to conventional whole breast external beam radiotherapy (EBRT) in terms of local cancer control. However, questions have been raised about the potential of f IORT to produce breast parenchymal changes that could interfere with mammographic surveillance of cancer recurrence. The purpose of this study was to identify, quantify, and compare the mammographic findings of patients who received IORT and EBRT in a prospective, randomized controlled clinical trial of women with early stage invasive breast cancer undergoing breast conserving therapy between July 2005 and December 2009. Treatment groups were compared with regard to the 1, 2 and 4-year incidence of 6 post-operative mammographic findings: architectural distortion, skin thickening, skin retraction, calcifications, fat necrosis, and mass density. Blinded review of 90 sets of mammograms of 15 IORT and 16 EBRT patients demonstrated a higher incidence of fat necrosis among IORT recipients at years 1, 2, and 4. However, none of the subjects were judged to have suspicious mammogram findings and fat necrosis did not interfere with mammographic interpretation.

scholarly journals Long-term Outcomes of Intraoperative Radiotherapy For Early-stage Breast Cancer in China: A Multicenter Real-World Study

2021 ◽  
Author(s):  
Xin Wang ◽  
Kexin Feng ◽  
Wenyan Wang ◽  
Xiangzhi Meng ◽  
Jiaqi Liu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Time ◽  
Early Stage ◽  
Intraoperative Radiotherapy ◽  
Disease Free Survival ◽  
Ipsilateral Breast Tumor Recurrence ◽  
Distant Metastases ◽  
Breast Conserving Surgery ◽  
Hematological Toxicity ◽  
Before And After

Abstract Background: To assess the efficacy, safety, and cosmetic effects of breast-conserving surgery (BCS) combined with intraoperative radiotherapy (IORT) in Chinese people. Methods: A retrospective analysis was performed on 451 patients who received IORT at four hospitals in China. IORT was delivered directly to the mammary gland before and after surgery. The primary endpoint was ipsilateral breast tumor recurrence (IBTR). The secondary endpoints were locoregional recurrence (LRR), overall survival (OS), disease-free survival (DFS), IORT-related toxicities, and cosmetic outcomes. Results: The median follow-up was 5.4 years (with a range of 1.0 to 11.9 years). The overall IBTR was 1.5%, LRR was 2.8%, and the OS rate and DFS rate were 96.2% and 99.1%, respectively. Only one (0.2%) breast cancer-related death was recorded. The cancer-related distant metastasis rate was 0.6%. There was no intraoperative or postoperative radiation-related acute hematological toxicity or other complications. Overall, 74.3% of patients graded the cosmetic effect as excellent or good. The LRR for pre-excision IORT was 3.0%, whereas that of post-excision IORT was 2.8% (pre-IORT vs. post-IORT, p=0.772). Distant metastases rate was 2.3% for pre-IORT and 1.8% for post-IORT (pre-IORT vs. post-IORT, p=0.692). The cancer-related death rate was 0.7% for pre-IORT and 0.0% for post-IORT (pre-IORT vs. post-IORT, p=0.899). The DFS rate was 94.7% in the pre-IORT group and 95.3% in the post-IORT group. (p=0.672). The LRR was 2.4%, whereas the OS rate was 99.5% after adjusting for the age of patients according to the recommended criteria by the American Society of Therapeutic Radiation Oncology (ASTRO), and the DFS rate was 98.1%. Conclusions: IORT significantly reduced the treatment time while preserving a high degree of locoregional control and cosmetic effects.

scholarly journals Assessment of Thyroid Dysfunction in Patients Irradiated for Head and Neck Malignancies

2020 ◽  
Vol 7 (45) ◽  
pp. 2626-2630
Author(s):  
Uma Maheswara Reddy U ◽  
Sameer Hussain K.M.
Keyword(s):  
Head And Neck ◽  
Early Stage ◽  
External Beam Radiotherapy ◽  
Neck Region ◽  
Thyroid Stimulating Hormone ◽  
External Beam ◽  
Radio Therapy ◽  
The Mean ◽  
Serum Tsh ◽  
Tsh Levels

BACKGROUND This study aims to assess the changes in serum TSH (Thyroid-Stimulating Hormone) in subjects with head & neck carcinoma treated with External Beam Radio-Therapy (EBRT) and study the usefulness of the serum TSH test to identify patients who develop early hypothyroidism in these subjects. METHODS This study involved assessing serum TSH in 50 patients diagnosed with biopsyproven squamous cell carcinoma in the head & neck region treated with external beam radiotherapy (EBRT). The study was designed as a prospective non interventional observational study. All patients underwent serum TSH test before the start of the radiation, at 2 months after the radiation and at 6 months after the radiation. All documented serum TSH levels were taken up for analysis. RESULTS Patient population was characterized by the distribution of patients in subsite of oral cavity in 18 (36 %) patients, hypopharynx in 11 (22 %) patients, larynx in 11 (22 %) patients, oropharynx in 9 (18 %) patients, and nasopharynx in 1 (2 %) patient. 12 (24 %) subjects were in Stage II, Stage III in 34 (68 %) subjects, and Stage IV in 4 (8 %) subjects. Mean TSH before radiotherapy was 1.93 ± 0.72 IU / mL. The mean TSH after 2 months of radiotherapy was 2.25 ± 0.97 IU / mL. The mean value after 6 months was 2.5 ± 1.3 IU / mL. The difference between the mean TSH values of 2 months and 6 months compared to baseline TSH is statistically significant (p < 0.0001 between 2 months and baseline and p < 0.0001 between 6 months and baseline). There was a 17 % increase in the TSH levels after 2 months of radiotherapy and a 30 % increase after 6 months of radiotherapy. CONCLUSIONS There is an increase in the serum TSH values both after 2 months and after 6 months of radiation and also may help in identifying patients with impending hypothyroidism at the early stage. KEYWORDS Radiotherapy, TSH, Thyroid, Hypothyroidism, Head and Neck Cancer

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