The Role of Intraoperative Radiation Therapy in the Management of Recurrent and Locally Advanced Gynecologic Cancers

2013 ◽  
Vol 23 (1) ◽  
pp. 9-15 ◽  
Author(s):  
Olivia W. Foley ◽  
J. Alejandro Rauh-Hain ◽  
Marcela G. del Carmen
Keyword(s):  
Radiation Therapy ◽  
Locally Advanced ◽  
Target Volume ◽  
External Beam Radiation ◽  
Intraoperative Radiation Therapy ◽  
Tumor Control ◽  
Gynecologic Cancers ◽  
Beam Radiation ◽  
Intraoperative Radiation

For patients with locally advanced primary or recurrent gynecologic cancers, prognosis is poor. Doses of external beam radiation therapy required to treat either gross or microscopic disease in patients previously irradiated or treated surgically exceed doses that are tolerated by normal anatomic structures. Intraoperative radiation therapy allows maximal tumor control achievable with radiation while minimizing radiation exposure of dose-limiting surrounding structures. Intraoperative radiation therapy is a unique treatment modality, allowing direct visualization of the target volume during a planned surgical procedure. Intraoperative radiation therapy has the potential to improve both long-term local control and overall survival especially in patients with para-aortic and/or pelvic sidewall recurrences.

scholarly journals First Intraoperative Radiation Therapy Center in Africa: First 2 Years in Operation, Including COVID-19 Experiences

2020 ◽  
pp. 1696-1703
Author(s):  
Yastira Ramdas ◽  
Carol-Ann Benn ◽  
Michelle van Heerden
Keyword(s):  
Radiation Therapy ◽  
Selection Criteria ◽  
Locally Advanced ◽  
External Beam Radiation ◽  
Intraoperative Radiation Therapy ◽  
Complication Rates ◽  
Luminal A ◽  
Beam Radiation ◽  
Intraoperative Radiation ◽  
Luminal B

PURPOSE There is a shortage of radiation therapy service centers in low- to middle-income countries. TARGIT–intraoperative radiation therapy (IORT) may offer a viable alternative to improve radiation treatment efficiency and alleviate hospital patient loads. The Breast Care Unit in Johannesburg became the first facility in Africa to offer TARGIT-IORT, and the purpose of this study was to present a retrospective review of patients receiving IORT at this center between November 2017 and May 2020. PATIENTS AND METHODS Patient selection criteria were based mainly on the latest American Society of Radiation Oncology guidelines. Selection criteria included early-stage breast carcinoma (luminal A) and luminal B with negative upfront sentinel lymph node biopsy that negated external-beam radiation therapy (EBRT). Patient characteristics, reasons for choosing IORT, histology, and use of oncoplastic surgery that resulted in complications were recorded. RESULTS One hundred seven patients successfully received IORT/TARGIT-IORT. Mean age was 60.8 years (standard deviation, 9.3 years). A total of 73.8% of patients presented with luminal A, 15.0% with luminal B, and 5.6% with triple-negative cancer. One patient who presented with locally advanced breast cancer (T4N2) opted for IORT as a boost in addition to planned EBRT. Eighty-seven patients underwent wide local excision (WLE) with mastopexy, and 12 underwent WLE with parenchymal. Primary reasons for selecting IORT/TARGIT-IORT were distance from the hospital (43.9%), choice (40.2%), and age (10.3%). CONCLUSION This retrospective study of IORT/TARGIT-IORT performed in Africa confirms its viability, with low complication rates and no detrimental effects with breast conservation, resulting in positive acceptance and the potential to reduce Oncology Center patient loads. Limitations of the study include the fact that only short-term data on local recurrence were available. Health and socioeconomic value models must still be addressed in the African setting.

Intraoperative Radiation Therapy

2007 ◽  
Vol 25 (8) ◽  
pp. 971-977 ◽  
Author(s):  
Christopher G. Willett ◽  
Brian G. Czito ◽  
Douglas S. Tyler
Keyword(s):  
Radiation Therapy ◽  
Local Control ◽  
Locally Advanced ◽  
Phase Iii ◽  
External Beam Radiation ◽  
Intraoperative Radiation Therapy ◽  
Partial Breast Irradiation ◽  
High Dose ◽  
Beam Radiation ◽  
Intraoperative Radiation

Intraoperative radiation therapy (IORT) is the delivery of irradiation at the time of an operation. This is performed by different techniques including intraoperative electron beam techniques and high-dose rate brachytherapy. IORT is usually given in combination with external-beam radiation therapy with or without chemotherapy and surgical resection. IORT excludes part or all dose-limiting sensitive structures, thereby increasing the effective dose to the tumor bed (and therefore local control) without significantly increasing normal tissue morbidity. Despite best contemporary therapy, high rates of local failure occur in patients with locally advanced or recurrent rectal cancer, retroperitoneal sarcoma, select gynecologic cancers, and other malignancies. The addition of IORT to conventional treatment methods has improved local control as well as survival in many disease sites in both the primary and locally recurrent disease settings. More recently, there has been interest in the use of IORT as a technique of partial breast irradiation for women with early breast cancer. Given newer and lower cost treatment devices, the use of IORT in clinical practice will likely grow, with increasing integration into the treatment of nonconventional malignancies. Optimally, phase III randomized trials will be carried out to prove its efficacy in these disease sites.

The role of misonidazole combined with intraoperative radiation therapy in the treatment of pancreatic carcinoma.

1987 ◽  
Vol 5 (4) ◽  
pp. 579-584 ◽  
Author(s):  
J E Tepper ◽  
W U Shipley ◽  
A L Warshaw ◽  
G L Nardi ◽  
W C Wood ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Locally Advanced ◽  
External Beam Radiation ◽  
Intraoperative Radiation Therapy ◽  
High Dose ◽  
Hypoxic Cell ◽  
External Beam ◽  
Beam Radiation ◽  
External Beam Irradiation ◽  
Intraoperative Radiation

We tested the efficacy of the hypoxic cell sensitizer misonidazole in conjunction with intraoperative electron beam radiation therapy (IORT) and external beam irradiation in patients with locally advanced, nonmetastatic adenocarcinoma of the pancreas. Misonidazole was delivered intravenously (IV) at a dose of 3.5 g/m2 in conjunction with IORT of 1,500 to 2,000 cGy to the pancreas. Additional external beam radiation as administered to 4,960 cGy. The study was based on the premise that the effect of misonidazole would be maximized when a high dose of the drug was administered and, thus, high hypoxic cell sensitization could be obtained when using a high single dose of radiation where the hypoxic fraction would be expected to dominate in the survivors. In a nonrandomized study of 41 patients treated with misonidazole and 22 without, the 1-year local control was 67% and 55%, and 1-year survival was 50% and 77%, respectively. Although there was a bias towards larger tumors in the patients treated with the sensitizer, we were unable to demonstrate an advantage to misonidazole in this clinical situation.

Multimodality salvage therapy for anal cancer failing standard chemoradiation

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15635-e15635
Author(s):  
Y. N. You ◽  
D. W. Larson ◽  
E. J. Dozois ◽  
H. Nelson ◽  
E. Antpack Filho ◽  
...  
Keyword(s):  
Overall Survival ◽  
Recurrent Disease ◽  
Perineal Wound ◽  
External Beam Radiation ◽  
Intraoperative Radiation Therapy ◽  
Beam Radiation ◽  
Intraoperative Radiation ◽  
Multimodality Approach ◽  
Pelvic Resection

e15635 Background: Most squamous cell carcinomas of the anal canal (SCC) respond to chemoradiation, but effective therapy for locally-invasive(T4) or recurrent disease that fails standard chemoradiation and/or salvage abdominoperineal resection (APR) has not been clearly delineated. A multimodality approach including chemoradiation, extended pelvic resection and intraoperative radiation therapy (IORT) was assessed for survival impact and treatment morbidity.morbidities. Methods: A prospective registry including 26 patients with locally-invasive or recurrent disease treated between 1993 and 2007 was reviewed. Primary endpoint was overall survival (OS), obtained from prospectively collected patient questionnaires and medical record review, and analyzed by the Kaplan-Meier method. Short (60-day postoperative) and long-term (median followup: 1.6 years; 5.3 years among survivors) complications were assessed. Results: Patients (median age: 51 years) presented with (1) locally-invasive disease that persisted despite initial standard chemoradiation (n=10, 39%), (2) disease that recurred after initial standard chemoradiation (n=10, 39%; median 1.7 years to recurrence), or (3) re-recurrence after a salvage APR (n=6, 23%; median 1.3 years since APR). All patients received chemotherapy and external beam radiation preoperatively, and 19% received additional postoperative chemoradiation. Gross pelvic disease was completely resected in all (R0 in 73%; R1 in 27%). IORT (750–3250cGy) was delivered at single (92%) or two sites (8%). Median overall survival (OS) was 1.7 years. Five-year OS were: 50%, 10%, and 22% for patients with locally-invasive, recurrent, and re-recurrent disease respectively. Short-term complications predominantly related to the perineal wound. Fifteen patients reported long-term complications (>grade3): bowel obstruction in 8 (1 requiring operation), perineal wound fistula/non-healing in 9, leg paresthesia in 5, hydronephrosis in 3. Conclusions: For select patients with locally-persistent or recurrent SCC who fail standard primary treatment, a multimodality approach involving chemoradiation, extended pelvic resection and IORT offers a chance for improved survival. No significant financial relationships to disclose.

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