The Use of Intraoperative Radiation Therapy (IORT) in Multimodality Management of Cancer Patients. A Single Institution Experience.

Background Intraoperative radiation therapy (IORT) is a highly conformal technique given in the operating room in many cancer sites for better tumor local control by increasing the tumor radiation dose without exceeding normal tissues tolerance doses.Purpose Assess the feasibility of Intra operative radiation therapy (IORT) and short-term toxicity in patients with different cancer sites treated with a multidisciplinary protocols including IORT.Patients & MethodsMedical records of cancer patients who received IORT at King Faisal Specialized Hospital and Research center(KFSHRC), Riyadh, Saudi Arabia from 2013 until 2017 were retrospectively reviewed.ResultsTotal 188 patients with 212 IORT applications were analyzed. Twenty-four patients had more than one application.116 patients were males. Median age at time of diagnosis was 49.5years (19-77). Hundred thirty four patients had primary while 54 cases had recurrent disease. Gastro esophageal cancer and soft tissue sarcoma were the most frequent diagnosis in 49 patients followed by colorectal cancer in 35 patients. Major surgeries with curative intent done in 183 patients (97.3%) and 118 patients (62.8%) had hyperthermic intraperitoneal chemotherapy (HIPEC) in addition to IORT. The 30days postoperative mortality rate was 3.2%. Fifty-three (28.2%) patients develop Grade III-IV complications according to Clavien-Dindo grading system. ConclusionThe data presented discussing treatment modalities for different malignant tumors which are treated and may benefit from using IORT technique as a part of multimodality treatment. IORT seems safe and feasible, however a longer follow-up is needed for proper evaluation and defining the role of IORT in tailored multimodality approach.

Surgical and Oncologic Outcomes With Intraoperative Radiation Therapy for Early Breast Cancer

Background For selected patients with early-stage breast cancer (BC), intraoperative radiation therapy (IORT) has emerged as a convenient alternative to standard whole breast irradiation (WBI). We report a single institution experience with IORT in terms of oncologic outcomes, toxicities, and cosmesis. Methods Clinicopathological and perioperative outcomes of patients who underwent IORT for early-stage BC at a public hospital from 2017 to 2020 were retrospectively retrieved. Toxicity was categorized to acute or chronic based on 6 months post-IORT cutoff. Results 85 patients underwent IORT and had complete data, aged 49‐85 years (mean 62). Intraoperative radiation therapy added 23 minutes on average to the total operative time. Final stage was 0, I, and II in 40%, 58.9%, and 1.1% of patients, respectively. Mean tumor size was 0.8 cm (range .1-2.1), with ductal histology comprising 94% of cases. Surgical margins were positive in 2 patients, and adjuvant WBI was required in 5 patients. After a median follow‐up of 17 months (range 3-41), none of the patients had local recurrence and no mortality was recorded. Early wound complications included wound dehiscence (n = 1), seroma/hematoma (n = 15), and re-operation with loss of nipple-areola complex (n = 1). Chronic skin toxicities were reported in 10 (12%) patients and good or excellent cosmetic outcome was reported in 93% of patients. Conclusions Utilizing IORT among low-risk early BC patients may be a safe and more convenient alternative to traditional WBI, with low toxicity rate, acceptable cosmetic results, and good oncologic outcomes at 17 months. Longer follow-up and further prospective controlled studies are needed to confirm these findings.

Intraoperative radiation therapy induces immune response activity after pancreatic surgery

Background Pancreatic cancer has highly aggressive features, such as local recurrence that leads to significantly high morbidity and mortality and recurrence after successful tumour resection. Intraoperative radiation therapy (IORT), which delivers targeted radiation to a tumour bed, is known to reduce local recurrence by directly killing tumour cells and modifying the tumour microenvironment. Methods Among 30 patients diagnosed with pancreatic cancer, 17 patients received IORT immediately after surgical resection. We investigated changes in the immune response induced by IORT by analysing the peritoneal fluid (PF) and blood of patients with and without IORT treatment after pancreatic cancer surgery. Further, we treated three pancreatic cell lines with PF to observe proliferation and activity changes. Results Levels of cytokines involved in the PI3K/SMAD pathway were increased in the PF of IORT-treated patients. Moreover, IORT-treated PF inhibited the growth, migration, and invasiveness of pancreatic cancer cells. Changes in lymphocyte populations in the blood of IORT-treated patients indicated an increased immune response. Conclusions Based on the characterisation and quantification of immune cells in the blood and cytokine levels in the PF, we conclude that IORT induced an anti-tumour effect by activating the immune response, which may prevent pancreatic cancer recurrence. Clinical trial registration NCT03273374.