scholarly journals Feasibility of intraoperative radiotherapy with X-rays for the treatment of superior sulcus tumours

2020 ◽  
Author(s):  
YI PAN ◽  
Xuening Yang ◽  
Zhiyong Chen ◽  
Yu Liang ◽  
Qingyi Hou ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Local Control ◽  
Neoadjuvant Chemoradiotherapy ◽  
Intraoperative Radiotherapy ◽  
Intensity Modulated Radiation Therapy ◽  
Low Energy ◽  
X Rays ◽  
Close Margin ◽  
Novel Therapy ◽  
Superior Sulcus

Abstract Background Preoperative concurrent chemoradiotherapy (CCRT) followed by surgery has become the standard treatment for potentially resectable superior sulcus (SS) tumours. To date, intraoperative radiotherapy (IORT) for SS tumour treatment is primarily performed via brachytherapy; it achieves high local control, but has no influence on overall survival. Therefore, a novel therapy is required to increase the local control of SS tumours. The purpose of this study was to evaluate the feasibility and safety of IORT with low-energy X-rays for treating SS tumours. Methods Patients diagnosed with stage IIB-IIIA SS tumours with chest wall invasion and scheduled to undergo surgery were eligible for this prospective pilot study. Every patient was discussed at a lung cancer multidisciplinary team meeting. Patients with potentially resectable tumour were scheduled for neoadjuvant chemoradiotherapy followed by surgery, while those with resectable tumour were scheduled to receive surgery alone. Neoadjuvant chemotherapy consisted of two cycles of platinum-based doublet chemotherapy. Concurrent radiotherapy of 50 Gy in 25 fractions over 5 weeks was performed via intensity-modulated radiation therapy. IORT was administered to the tumour bed with close margin. The primary endpoint was acute toxicity and secondary endpoints were late spinal cord and brachial plexus toxicity. Results Between August 22, 2014 and November 30, 2017, we enrolled nine patients (seven males and two females). Anaemia was the most common acute complication, with grade 3 anaemia occurring in three patients who received preoperative CCRT. Other side effects included pneumonia (1 patient), prolonged air leakage (1), and grade 1 brachial plexus injury (1). The average follow-up period was 29.4 (range; 13.3-50.4) months. All patients are alive. Distant metastasis was observed in two patients, one with contralateral lung metastasis and another with pericardial metastasis. Conclusions IORT with low-energy X-rays is a technically feasible and relatively safe treatment modality for patients with superior pulmonary sulcus tumours.

scholarly journals EP-1210 Local control and toxicity of IORT with low energy X-rays after resection of brain metastasis

2019 ◽  
Vol 133 ◽  
pp. S670
Author(s):  
H. Kahl ◽  
S. Sabine ◽  
M. Heiko ◽  
G. Ute ◽  
K. Ina ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Local Control ◽  
Low Energy ◽  
X Rays

Treatment of diatal rectal cancer with preoperative intensity-modulated radiation therapy (IMRT) combined with chemotherapy: Updated 5-year results of 42 patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14157-e14157
Author(s):  
Albert S. DeNittis ◽  
John Marks ◽  
Filip Troicki ◽  
Erik L. Zeger ◽  
George Nassif ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Local Control ◽  
Medical Center ◽  
Neoadjuvant Chemoradiotherapy ◽  
Intensity Modulated Radiation Therapy ◽  
Intensity Modulated ◽  
Distal Rectal Cancer

e14157 Background: Preoperative chemoradiotherapy is currently the standard of care for patients with distal rectal cancer. With Intensity Modulated Radiation Therapy (IMRT), more conformal doses of radiation can be delivered to tumor while sparing normal tissue. It is our intent to present updated data showing 5 year follow up on patients treated concurrently with chemotherapy and IMRT reporting on local control, overall survival, and toxicity. Methods: From April 2007 to February of 2012 a sequential retrospective study of 42 patients at Lankenau Medical Center were treated for distal rectal cancer using IMRT. Patients staged from T2N0M0 to T3N1M0 and all received 5580 cGy to the pelvis using a 9 field plan to tumor, involved and uninvolved lymph nodes. All but one patient received 5FU based chemotherapy and four patients also received oxaliplatin. All patients then went on to surgery 8 – 12 weeks following neoadjuvant therapy. Twenty six patients underwent transabdominal transanal mesorectal (TATA) resection, 9 patients underwent a transanal endoscopic microsurgery (TEM), and 1 patient had an open low anterior resection. 3 patients have yet to go to surgery. FOLFOX was given to 25 of 42 patients adjuvently. Patients were analyzed for local control (LC), median survival (MS), overall survival (OS), and toxicity. Results: The median follow-up was 35 months. Complete pathological response was achieved in 12 (30.7%) patients, partial response was achieved in 25 (64%) patients, and 2 had stable disease at the time of surgery. There were no patients with local failure and only six (14%) patients progressed with distant metastatic disease. OS at 5 years was 92.8% with a MS of 37 months. Toxicity was acceptable with eight patients with grade 1, 5 patients with grade 2, and 3 grade 3 diarrhea. There were 3 (7%) patients with grade 1 neutropenia. Three patients experienced disease related death. Conclusions: With 5 years of follow-up data, our experience has shown that neoadjuvant chemoradiotherapy using IMRT to treat advanced stage rectal cancer is well tolerated and effective. Still further follow-up and additional studies will be required to confirm our findings.

P93 Long-term toxicity of an intraoperative radiotherapy (IORT) boost using low energy X-rays during breast conserving surgery (BCS)

The Breast ◽  
2007 ◽  
Vol 16 ◽  
pp. S39
Author(s):  
U. Kraus-Tiefenbacher ◽  
L. Bauer ◽  
A. Scheda ◽  
K. Fleckenstein ◽  
A. Keller ◽  
...  
Keyword(s):  
Intraoperative Radiotherapy ◽  
Breast Conserving Surgery ◽  
Low Energy ◽  
X Rays

Radiobiological Aspects of Intraoperative Radiotherapy (IORT) with Isotropic Low-Energy X Rays for Early-Stage Breast Cancer

2005 ◽  
Vol 163 (2) ◽  
pp. 208-215 ◽  
Author(s):  
Carsten Herskind ◽  
Volker Steil ◽  
Uta Kraus-Tiefenbacher ◽  
Frederik Wenz
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Intraoperative Radiotherapy ◽  
Low Energy ◽  
Early Stage Breast Cancer ◽  
X Rays

Impact of Intensity-Modulated Radiation Therapy on Local Control in Primary Soft-Tissue Sarcoma of the Extremity

2008 ◽  
Vol 26 (20) ◽  
pp. 3440-3444 ◽  
Author(s):  
Kaled M. Alektiar ◽  
Murray F. Brennan ◽  
John H. Healey ◽  
Samuel Singer
Keyword(s):  
Radiation Therapy ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Local Control ◽  
Intensity Modulated Radiation Therapy ◽  
Local Control Rate ◽  
Bone Resection ◽  
Close Margin ◽  
Intensity Modulated

Purpose One of the concerns about intensity-modulated radiation therapy (IMRT) is that its tight dose distribution, an advantage in reducing RT morbidity to surrounding normal structures, might compromise tumor coverage. The purpose of this study is to determine if such concern is warranted in soft-tissue sarcoma (STS) of the extremity. Methods Between 02/02 and 05/05, 41 adult patients with primary STS of the extremity were treated with limb-sparing surgery and adjuvant IMRT. The margins were positive/within 1 mm in 21. Tumor size was more than 10 cm in 68% of patients and grade was high in 83%. Preoperative IMRT was given to 7 patients (50 Gy) and postoperative IMRT (median dose, 63 Gy) was given to 34 patients. Complete gross resection including periosteal stripping/bone resection was required in 11, and neurolysis/nerve resection in 24. Results With a median follow-up time of 35 months, two (4.8%) of 41 patients developed local recurrence. The 5-year actuarial local control rate was 94% (95% CI, 86% to 100%). The local control rate was also 94% for patients with negative or positive/close margin. Other prognostic factors such as age, size, and grade did not impact local control either. The 5-year distant control rate was 61% (95% CI, 45% to 76%) and the overall survival rate was 64% (95% CI, 45% to 84%). Conclusion IMRT in STS of the extremity provides excellent local control in a group of patients with high risk features. This suggests that the precision with which IMRT dose is distributed has a beneficiary effect in sparing normal tissue and improving local control.

scholarly journals RTHP-05. INTRAOPERATIVE RADIOTHERAPY (IORT) USING LOW-ENERGY X-RAYS IN A COHORT OF PREDOMINANTLY INCOMPLETELY RESECTED NEWLY DIAGNOSED GLIOBLASTOMA MULTIFORME (INTRAGO TRIAL)

2016 ◽  
Vol 18 (suppl_6) ◽  
pp. vi174-vi175 ◽  
Author(s):  
Frank Anton Giordano ◽  
Stefanie Brehmer ◽  
Bettina Mürle ◽  
Grit Welzel ◽  
Elena Sperk ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Intraoperative Radiotherapy ◽  
Low Energy ◽  
X Rays ◽  
Newly Diagnosed ◽  
Newly Diagnosed Glioblastoma

Intraoperative radiotherapy (IORT) with low-energy x-rays for breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 607-607
Author(s):  
U. S. Kraus-Tiefenbacher ◽  
C. Herskind ◽  
L. Bauer ◽  
A. Scheda ◽  
F. Wenz
Keyword(s):  
Breast Cancer ◽  
Tumour Size ◽  
Intraoperative Radiotherapy ◽  
Low Energy ◽  
Quadratic Model ◽  
Partial Breast Irradiation ◽  
X Rays ◽  
X Ray

607 Background: IORT for breast cancer using either electrons or low-energy x-rays is of increasing interest over the last few years. In our institution, IORT is delivered by a mobile x-ray source (Intrabeam™) producing isotropic 50 kV x-ray fields. Because this treatment method includes single high doses to the normal breast tissue, careful and long-term evaluation of early and late toxicity is mandatory. To date there are still fewdata on long-term follow-up of patients treated with low-energy x-rays. Methods: Between 2/02 and 12/06 204 breast cancer patients received IORT either as a tumour-bed boost (133) followed by 46 Gy external beam radiotherapy (EBRT) or as partial breast irradiation (PBI) only (71). Median age was 66.4 years (35–95), median tumour size was 9 mm (1–45). Spherical applicators (median 4. 0 cm) were inserted into the tumour-cavity and a single dose of 20 Gy was given. Follow-up (f/u) included physical examination and ultrasound 1 week, 2 months, then every 6 months after therapy and mammography at yearly intervals. Radiobiological modelling of the expected spatial distribution of late reactions was done for typical cases using the linear-quadratic model with special consideration of relative biological effectiveness, spatial dose distribution and dose rate. Results: Median f/u was 28 months (1–56). Minor postoperative side effects included erythema (5%), delayed wound healing (4%), mastitis (1%) and hematoseroma (4%). A fibrotic induration of the tumour bed was observed in 9, 18, 24, 23, 26% and 24% of the patients at 2, 6 12, 24, 36 and 48 month f/u. These fibrosis rates were distributed equally in both groups. Reoperation was required in 2 patients after 10 (fibrosis) and 12 months (fat necrosis). Conclusions: Although two thirds of the patients were treated with a combination of IORT and EBRT, acute reactions in all patients were mild. A fibrotic induration confined to the tumourbed was observed in up to 25% of all patients after 2 years. The low level of clinically observed late reactions so far is in agreement with predictions from radiobiological modelling. No significant financial relationships to disclose.

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