scholarly journals Boost IORT in Breast Cancer: Body of Evidence

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Felix Sedlmayer ◽  
Roland Reitsamer ◽  
Christoph Fussl ◽  
Ingrid Ziegler ◽  
Franz Zehentmayr ◽  
...  
Keyword(s):  
Postoperative Radiotherapy ◽  
External Beam Radiotherapy ◽  
Intraoperative Radiotherapy ◽  
Multicenter Trial ◽  
Patient Comfort ◽  
Dose Delivery ◽  
Recurrence Rates ◽  
Accurate Dose ◽  
Electron Boost

The term IORT (intraoperative radiotherapy) is currently used for various techniques that show decisive differences in dose delivery. The largest evidence for boost IORT preceding whole breast irradiation (WBI) originates from intraoperative electron treatments with single doses around 10 Gy, providing outstandingly low local recurrence rates in any risk constellation also at long term analyses. Compared to other boost methods, an intraoperative treatment has evident advantages as follows.Precision.Direct visualisation of the tumour bed during surgery guarantees an accurate dose delivery. This fact has additionally gained importance in times of primary reconstruction techniques after lumpectomy to optimise cosmetic outcome. IORT is performed before breast tissue is mobilised for plastic purposes.Cosmesis.As a consequence of direct tissue exposure without distension by hematoma/seroma, IORT allows for small treatment volumes and complete skin sparing, both having a positive effect on late tissue tolerance and, hence, cosmetic appearance.Patient Comfort.Boost IORT marginally prolongs the surgical procedure, while significantly shortening postoperative radiotherapy. Its combination with a 3-week hypofractionated external beam radiotherapy to the whole breast (WBI) is presently tested in the HIOB trial (hypofractionated WBI preceded by IORT electron boost), a prospective multicenter trial of the International Society of Intraoperative Radiotherapy (ISIORT).

scholarly journals Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial

BMJ ◽  
2020 ◽  
pp. m2836 ◽  
Author(s):  
Jayant S Vaidya ◽  
Max Bulsara ◽  
Michael Baum ◽  
Frederik Wenz ◽  
Samuele Massarut ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Single Dose ◽  
Local Recurrence ◽  
Early Breast Cancer ◽  
External Beam Radiotherapy ◽  
Breast Cancer Mortality ◽  
Intraoperative Radiotherapy ◽  
Term Survival ◽  
Free Survival

AbstractObjectiveTo determine whether risk adapted intraoperative radiotherapy, delivered as a single dose during lumpectomy, can effectively replace postoperative whole breast external beam radiotherapy for early breast cancer.DesignProspective, open label, randomised controlled clinical trial.Setting32 centres in 10 countries in the United Kingdom, Europe, Australia, the United States, and Canada.Participants2298 women aged 45 years and older with invasive ductal carcinoma up to 3.5 cm in size, cN0-N1, eligible for breast conservation and randomised before lumpectomy (1:1 ratio, blocks stratified by centre) to either risk adapted targeted intraoperative radiotherapy (TARGIT-IORT) or external beam radiotherapy (EBRT).InterventionsRandom allocation was to the EBRT arm, which consisted of a standard daily fractionated course (three to six weeks) of whole breast radiotherapy, or the TARGIT-IORT arm. TARGIT-IORT was given immediately after lumpectomy under the same anaesthetic and was the only radiotherapy for most patients (around 80%). TARGIT-IORT was supplemented by EBRT when postoperative histopathology found unsuspected higher risk factors (around 20% of patients).Main outcome measuresNon-inferiority with a margin of 2.5% for the absolute difference between the five year local recurrence rates of the two arms, and long term survival outcomes.ResultsBetween 24 March 2000 and 25 June 2012, 1140 patients were randomised to TARGIT-IORT and 1158 to EBRT. TARGIT-IORT was non-inferior to EBRT: the local recurrence risk at five year complete follow-up was 2.11% for TARGIT-IORT compared with 0.95% for EBRT (difference 1.16%, 90% confidence interval 0.32 to 1.99). In the first five years, 13 additional local recurrences were reported (24/1140 v 11/1158) but 14 fewer deaths (42/1140 v 56/1158) for TARGIT-IORT compared with EBRT. With long term follow-up (median 8.6 years, maximum 18.90 years, interquartile range 7.0-10.6) no statistically significant difference was found for local recurrence-free survival (hazard ratio 1.13, 95% confidence interval 0.91 to 1.41, P=0.28), mastectomy-free survival (0.96, 0.78 to 1.19, P=0.74), distant disease-free survival (0.88, 0.69 to 1.12, P=0.30), overall survival (0.82, 0.63 to 1.05, P=0.13), and breast cancer mortality (1.12, 0.78 to 1.60, P=0.54). Mortality from other causes was significantly lower (0.59, 0.40 to 0.86, P=0.005).ConclusionFor patients with early breast cancer who met our trial selection criteria, risk adapted immediate single dose TARGIT-IORT during lumpectomy was an effective alternative to EBRT, with comparable long term efficacy for cancer control and lower non-breast cancer mortality. TARGIT-IORT should be discussed with eligible patients when breast conserving surgery is planned.Trial registrationISRCTN34086741, NCT00983684.

scholarly journals Intraoperative radiotherapy electron boost followed by moderate doses of external beam radiotherapy in resected soft-tissue sarcoma of the extremities

2003 ◽  
Vol 67 (3) ◽  
pp. 331-337 ◽  
Author(s):  
Ignacio Azinovic ◽  
Rafael Martinez Monge ◽  
Jose Javier Aristu ◽  
Esteban Salgado ◽  
Elena Villafranca ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
External Beam Radiotherapy ◽  
Intraoperative Radiotherapy ◽  
External Beam ◽  
Electron Boost

scholarly journals Single-dose intraoperative radiotherapy during lumpectomy for breast cancer: an innovative patient-centred treatment

2021 ◽  
Author(s):  
Jayant S. Vaidya ◽  
◽  
Max Bulsara ◽  
Michael Baum ◽  
Jeffrey S. Tobias
Keyword(s):  
Breast Cancer ◽  
Single Dose ◽  
Local Recurrence ◽  
External Beam Radiotherapy ◽  
Intraoperative Radiotherapy ◽  
External Beam ◽  
Breast Cancer Outcome ◽  
Cancer Outcome

SummaryIn the randomised TARGIT-A trial, risk-adapted targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy was non-inferior to whole-breast external beam radiotherapy, for local recurrence. In the long-term, no difference was found in any breast cancer outcome, whereas there were fewer deaths from non-breast-cancer causes. TARGIT-IORT should be included in pre-operative consultations with eligible patients.

Treatment of intraductal carcinoma with limited surgery: long-term follow-up.

1989 ◽  
Vol 7 (3) ◽  
pp. 376-380 ◽  
Author(s):  
W J Gallagher ◽  
F C Koerner ◽  
W C Wood
Keyword(s):  
Local Recurrence ◽  
Ductal Carcinoma ◽  
Postoperative Radiotherapy ◽  
Breast Conservation ◽  
Recurrence Rates ◽  
Limited Surgery ◽  
Long Term Follow Up ◽  
Invasive Carcinomas

Adequate therapy for ductal carcinoma in situ (DCIS) remains controversial. In spite of limited follow-up, recent studies advocate excision and postoperative radiotherapy as treatment. In an effort to provide long-term follow-up information, we evaluated retrospectively a group of 17 patients treated without mastectomy. Thirteen patients were treated with local excision, while four received excision and postoperative radiotherapy. Median follow-up is 100 months, with minimum follow-up 78 months. Five patients (29%) have recurred locally, at a median of 47 months following initial therapy. Three of the local recurrences were invasive carcinomas; two were DCIS. The patients recurring with invasive carcinoma progressed to disseminated disease and death, at a median of 131 months following their local recurrence. Of the eight patients followed for more than 9 years, four (50%) have recurred. Two patients have developed contralateral breast cancer, both treated by mastectomy. No recurrences have occurred in the group receiving radiotherapy. We conclude that long-term follow-up is required to accurately assess local recurrence rates in this disease, and that many recurrences will be invasive carcinomas. Since this lesion is virtually 100% curable by mastectomy, further analysis of long-term studies is warranted before recommending breast conservation to the majority of patients with DCIS.

Long-term remission and recurrence rates after transsphenoidal surgery for cushing's disease

2014 ◽  
Author(s):  
Paloma Moreno Moreno ◽  
Julia Silva Fernandez ◽  
Maria Rosa Alhambra Exposito ◽  
Maria angeles Galvez Moreno
Keyword(s):  
Cushing’S Disease ◽  
Transsphenoidal Surgery ◽  
Cushing's Disease ◽  
Recurrence Rates

scholarly journals Focused VHEE (very high energy electron) beams and dose delivery for radiotherapy applications

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
L. Whitmore ◽  
R. I. Mackay ◽  
M. van Herk ◽  
J. K. Jones ◽  
R. M. Jones
Keyword(s):  
Electron Beams ◽  
Focal Point ◽  
External Beam Radiotherapy ◽  
High Energy ◽  
Energy Electron ◽  
High Energy Electron ◽  
Dose Delivery ◽  
Entrance Dose ◽  
Very High Energy ◽  
Very High

AbstractThis paper presents the first demonstration of deeply penetrating dose delivery using focused very high energy electron (VHEE) beams using quadrupole magnets in Monte Carlo simulations. We show that the focal point is readily modified by linearly changing the quadrupole magnet strength only. We also present a weighted sum of focused electron beams to form a spread-out electron peak (SOEP) over a target region. This has a significantly reduced entrance dose compared to a proton-based spread-out Bragg peak (SOBP). Very high energy electron (VHEE) beams are an exciting prospect in external beam radiotherapy. VHEEs are less sensitive to inhomogeneities than proton and photon beams, have a deep dose reach and could potentially be used to deliver FLASH radiotherapy. The dose distributions of unfocused VHEE produce high entrance and exit doses compared to other radiotherapy modalities unless focusing is employed, and in this case the entrance dose is considerably improved over existing radiations. We have investigated both symmetric and asymmetric focusing as well as focusing with a range of beam energies.

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