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Intraoperative Radiotherapy

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https://www.readbyqxmd.com/read/28717856/intraoperative-radiotherapy-for-extremity-soft-tissue-sarcomas-can-long-term-local-control-be-achieved
#1
Esther Carbó-Laso, Pablo Sanz-Ruiz, José Antonio Calvo-Haro, Miguel Cuervo-Dehesa, Rubén Pérez-Mañanes, Lydia Mediavilla-Santos, Coral Sánchez-Pérez, Ana Álvarez-González, Javier Vaquero-Martín
BACKGROUND: Intraoperative electron-beam radiation therapy (IOERT) during limb-sparing surgery has the advantage of delivering a single high boost dose to sarcoma residues and surgical bed area near to radiosensitive structures with limited toxicity. Retrospective studies have suggested that IOERT may improve local control compared to standard radiotherapy and we aimed to demonstrate this theory. Therefore, we performed an observational prospective study to determine (1) if it is possible to achieve high local control by adding IOERT to external-beam radiation therapy (EBRT) in extremity soft-tissue sarcomas (STS), (2) if it is possible to improve long-term survival rates, and (3) if toxicity could be reduced with IOERT MATERIALS AND METHODS: From 1995-2003, 39 patients with extremity STS were treated with IOERT and postoperative radiotherapy...
July 17, 2017: International Journal of Clinical Oncology
https://www.readbyqxmd.com/read/28717396/intraoperative-radiotherapy-review-of-techniques-and-results
#2
REVIEW
Avinash Pilar, Meetakshi Gupta, Sarbani Ghosh Laskar, Siddhartha Laskar
Intraoperative radiotherapy (IORT) is a technique that involves precise delivery of a large dose of ionising radiation to the tumour or tumour bed during surgery. Direct visualisation of the tumour bed and ability to space out the normal tissues from the tumour bed allows maximisation of the dose to the tumour while minimising the dose to normal tissues. This results in an improved therapeutic ratio with IORT. Although it was introduced in the 1960s, it has seen a resurgence of popularity with the introduction of self-shielding mobile linear accelerators and low-kV IORT devices, which by eliminating the logistical issues of transport of the patient during surgery for radiotherapy or building a shielded operating room, has enabled its wider use in the community...
2017: Ecancermedicalscience
https://www.readbyqxmd.com/read/28715150/intraoperative-radiotherapy-patient-selection-management-and-follow-up
#3
REVIEW
Dennis R Holmes, Robert Zimmerman
Intraoperative partial breast radiotherapy is an alternative or an adjunct to fractionated whole breast irradiation for the administration of adjuvant radiotherapy in breast cancer following breast conserving surgery. Establishing intraoperative radiotherapy as a therapeutic modality requires a multidisciplinary approach to patient selection, workup, surgery, radiation protocols, chemotherapy, and patient follow up. In this article, we review the published evidence for best clinical practice, as a guide to the introduction of intraoperative radiotherapy for breast cancer treatment...
July 17, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28712278/in-vivo-dosimetry-and-acute-toxicity-in-breast-cancer-patients-undergoing-intraoperative-radiotherapy-as-boost
#4
Jason Joon Bock Lee, Jinhyun Choi, Sung Gwe Ahn, Joon Jeong, Ik Jae Lee, Kwangwoo Park, Kangpyo Kim, Jun Won Kim
PURPOSE: To report the results of a correlation analysis of skin dose assessed by in vivo dosimetry and the incidence of acute toxicity. This is a phase 2 trial evaluating the feasibility of intraoperative radiotherapy (IORT) as a boost for breast cancer patients. MATERIALS AND METHODS: Eligible patients were treated with IORT of 20 Gy followed by whole breast irradiation (WBI) of 46 Gy. A total of 55 patients with a minimum follow-up of 1 month after WBI were evaluated...
June 2017: Radiation Oncology Journal
https://www.readbyqxmd.com/read/28708603/monte-carlo-skin-dose-simulation-in-intraoperative-radiotherapy-of-breast-cancer-using-spherical-applicators
#5
Farhad Moradi, Ngie Min Ung, M U Khandaker, Ghafour Amouzad Mahdiraji, Marniza Saad, Rozita Abdul Malik, Anita Zarina Bustam, Zainor Zaili, David A Bradley
The relatively new treatment modality electronic intraoperative radiotherapy (IORT) is gaining popularity, irradiation being obtained within a surgically produced cavity being delivered via a low-energy X-ray source and spherical applicators, primarily for early stage breast cancer. Due to the spatially dramatic dose-rate fall off with radial distance from the source and effects related to changes in the beam quality of the low keV photon spectra, dosimetric account of the Intrabeam system is rather complex...
July 14, 2017: Physics in Medicine and Biology
https://www.readbyqxmd.com/read/28697002/re-irradiation-of-cervical-and-endometrial-cancer
#6
Megan Llewelyn, Alexandra Taylor
PURPOSE OF REVIEW: Re-irradiation historically has been associated with unacceptable toxicity and limited benefit. Recent advances in radiotherapy can change the treatment paradigm to provide new salvage treatments for recurrences of cervical and endometrial cancer. RECENT FINDINGS: Image-guided brachytherapy is an effective method for salvaging central pelvic recurrence, although it has resulted in 20-25% severe late toxicity. Pelvic sidewall disease is not accessible to brachytherapy, so a combined modality approach with radical surgery and intraoperative radiotherapy is an alternative approach...
July 10, 2017: Current Opinion in Oncology
https://www.readbyqxmd.com/read/28690675/development-of-sentinel-node-biopsy-roll-and-iart-in-early-breast-cancer-at-the-european-institute-of-oncology-milan-ieo
#7
REVIEW
Giovanni Paganelli
The problem of unnecessary axillary clearance in many patients with early breast cancer was certainly a major issue at IEO when we started working with Prof. Umberto Veronesi in 1994. At that time, axillary dissection in EBC was offered to all patients and this procedure was often hotly debated during our multidisciplinary breast cancer meetings. The question as to whether we could avoid axillary dissection by using PET scans or other nuclear medicine methods was frequently asked by Veronesi. This eventually prompted us to investigate whether, as for melanoma patients, the sentinel node biopsy (SNB) approach could reliably be applied to breast cancer...
2017: Ecancermedicalscience
https://www.readbyqxmd.com/read/28681156/margin-proximity-correlates-with-local-recurrence-after-mastectomy-for-patients-not-receiving-adjuvant-radiotherapy
#8
Jaime M Glorioso, Alexandra B Gonzalez Juarrero, Brian R Rodysill, William S Harmsen, Elizabeth B Habermann, Jodi M Carter, Robert W Mutter, Amy C Degnim, James W Jakub
BACKGROUND: Although considerable evidence exists regarding margin status and reexcision for patients undergoing breast conservation therapy, few data address the impact of a close margin for patients undergoing mastectomy without postmastectomy radiotherapy. METHODS: This retrospective review identified 1147 patients who underwent 1206 mastectomies with negative final margins for breast cancer from 2006 to 2010. Margin distance was analyzed as a continuous variable and dichotomized variable ((≤2 vs >2 mm)...
July 5, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28677936/impact-of-optic-canal-decompression-on-visual-outcome-in-subtotal-resected-skull-base-meningiomas
#9
Meike Unteroberdörster, Oliver Müller, Neriman Özkan, Daniela Pierscianek, Martin Hadamitzky, Bernadette Kleist, Ulrich Sure, Nicolai El Hindy
BACKGROUND: Visual impairment (VI) due to neoplastic infiltration of the optic canal (OC) is frequently seen in skull base meningiomas representing a significant restriction in patients` quality of life. However, the delicate anatomy of this region often prevents gross total tumor resection. The aim of the present study was to evaluate the impact of intradural OC decompression and postoperative oncological procedure on preservation of visual acuity in subtotal resected skull base meningiomas...
July 4, 2017: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/28673535/nipple-sparing-and-skin-sparing-mastectomy-review-of-aims-oncological-safety-and-contraindications
#10
Viviana Galimberti, Elisa Vicini, Giovanni Corso, Consuelo Morigi, Sabrina Fontana, Virgilio Sacchini, Paolo Veronesi
Skin-sparing (SSM) and nipple-sparing (NSM) mastectomies are relatively new conservative surgical approaches to breast cancer. In SSM most of the breast skin is conserved to create a pocket that facilitates immediate breast reconstruction with implant or autologous graft to achieve a quality cosmetic outcome. NSM is closely similar except that the nipple-areola complex (NAC) is also conserved. Meta-analyses indicate that outcomes for SSM and NSM do not differ from those for non-conservative mastectomies. Recurrence rates in the NAC after NSM are acceptably low (0-3...
June 30, 2017: Breast: Official Journal of the European Society of Mastology
https://www.readbyqxmd.com/read/28673534/the-intraoperative-assessment-of-sentinel-nodes-standards-and-controversies
#11
M E M van der Noordaa, M T F D Vrancken Peeters, E J T Rutgers
Intraoperative assessment of sentinel lymph nodes (SLNs) has the advantage of allowing breast cancer patients with tumor-positive SLNs to avoid a second surgery by immediately proceeding to axillary lymph node dissection (ALND). However, there are several reasons why the use of intraoperative assessment should be questioned. Whereas ALND was traditionally advised for all breast cancer patients with tumor-positive lymph nodes for axillary staging and locoregional control, more recent studies have demonstrated safety of omitting ALND in a substantial number of patients...
June 30, 2017: Breast: Official Journal of the European Society of Mastology
https://www.readbyqxmd.com/read/28660324/-r1-resection-for-gastric-carcinoma
#12
REVIEW
K Ridwelski, J Fahlke, M Huß, R Otto, S Wolff
The results reported in the literature in the context of an R1 situation for a resected gastric carcinoma are not uniform. An R1 situation worsens the prognosis for the long-term survival of patients. This is significant especially for low T stages and lymph node metastasis with 0-≤3 lymph node metastases. In higher tumor stages with extensive lymph node metastases, the survival difference between R0 and R1 resections is lower and frequently no longer significant. The frequency of R1 resection is approximately 5% (range 1...
June 28, 2017: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
https://www.readbyqxmd.com/read/28616793/pelvic-exenteration-with-en-bloc-resection-of-the-pelvic-sidewall-and-intraoperative-electron-beam-radiotherapy-with-mobetron-%C3%A2-for-locally-advanced-rectal-cancer
#13
K Rangarajan, R Bhome, N Bateman, A Naga, M Simon, K Donovan, J Smith, A H Mirnezami
No abstract text is available yet for this article.
June 2017: Techniques in Coloproctology
https://www.readbyqxmd.com/read/28613934/standard-fractionation-external-beam-radiotherapy-with-and-without-intraoperative-radiotherapy-for-locally-recurrent-rectal-cancer-the-role-of-local-therapy-in-patients-with-a-high-competing-risk-of-death-from-distant-disease
#14
Amar U Kishan, Justin C Voog, Jonathan Wiseman, Ryan R Cook, Marek Ancukiewicz, Percy Lee, David P Ryan, Jeffrey W Clark, David L Berger, James C Cusack, Jennifer Y Wo, Theodore S Hong
OBJECTIVES: We sought to evaluate the effectiveness and safety of utilizing radiotherapy (RT) with standard fractionation, with or without intraoperative radiotherapy (IORT), to treat locally recurrent rectal cancer (LRRC). METHODS: Retrospective review of 25 patients with LRRC treated with standard fractionation RT from 2005-2011. Fifteen patients (60%) had prior pelvic RT and ten (40%) had synchronous metastases. The median equivalent dose in 2 Gy fractions was 30 Gy and 49...
June 14, 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/28608393/the-impact-of-the-use-of-intraoperative-radiotherapy-on-costs-travel-time-and-distance-for-women-with-breast-cancer-in-the-mexico-city-metropolitan-area
#15
Juan Enrique Bargallo-Rocha, Enrique Soto-Perez-de-Celis, Francisco Javier Picó-Guzmán, Carlos Eduardo Quintero-Rodríguez, David Almog, Gabriel Santiago-Concha, Christian Haydee Flores-Balcazar, Jaime Corona, Rafael Vazquez-Romo, Cynthia Villarreal-Garza, Alejandro Mohar
BACKGROUND AND OBJECTIVES: The low availability and poor access to external beam radiotherapy (EBRT) in developing countries makes it hard for women with breast cancer to receive breast conservation. We studied the effect of providing intraoperative radiotherapy (IORT) on the travel time, distance, and costs of in the Mexico City Metropolitan Area (MCMA). METHODS: Sixty-nine patients treated between January 2013 and September 2014 were analyzed. Travel distance and transit time was calculated using Google Maps...
June 12, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28608120/cosmetic-outcome-and-chronic-breast-toxicity-after-intraoperative-radiation-therapy-iort-as-a-single-modality-or-as-a-boost-using-the-intrabeam-%C3%A2-device-a-prospective-study
#16
Stéphane Key, Petra Miglierini, Pierre-François Dupré, Sandrine Guilbert, Anne-Sophie Lucia, Ronan Abgral, Virginie Conan-Charlet, Arnaud Uguen, Olivier Pradier, Ulrike Schick
PURPOSE: We aim to report our results in terms of chronic toxicities and cosmetic outcomes after intraoperative radiotherapy (IORT) using kV X-rays in women treated for early breast cancer at our institution. METHODS: Patients with early breast carcinoma were recruited between April 2011 and November 2014. After breast-conserving surgery, patients were treated with IORT using the Intrabeam(®) device. IORT was completed by whole-breast radiotherapy (WBRT) at a dose of 46-50...
June 12, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28604998/role-of-radiotherapy-in-the-treatment-of-renal-cell-cancer-updated-and-critical-review
#17
Vincenzo Fusco, Salvatore Parisi, Barbara d'Andrea, Michele Troiano, Maria Antonietta Clemente, Franco Morelli, Rocchina Caivano, Giuseppe Guglielmi
PURPOSE: The growing incidence of renal cell carcinoma (RCC) raises many questions about the management of these patients. The late clinical presentation, the presence of locally advanced or metastatic disease at diagnosis, the difficulty of radical surgical excision, and radioresistance make it one of the more challenging tumors to treat. The primary objective of this article is to propose an updated and critical review of the role of radiotherapy (RT) in the treatment of RCC. METHODS: This literature review is based on data from meta-analyses and randomized, prospective, and retrospective studies...
June 6, 2017: Tumori
https://www.readbyqxmd.com/read/28579359/evolution-in-treatment-strategy-for-metastatic-spine-disease-presently-evolving-modalities
#18
REVIEW
N Kumar, R Malhotra, A S Zaw, K Maharajan, N Naresh, A Kumar, B Vellayappan
The advent of minimally invasive surgery (MIS) in the surgical management armamentarium and stereotactic radiosurgery in the domain of radiotherapy, has led to a major evolution in treatment of metastatic spine disease (MSD). We reviewed the recent literature to discuss evolution from open to MIS approaches in MSD and the concurrent evolution in radiotherapy. This will provide a sound base for further development and understanding of treatment paradigms in MSD. Literature review showed that evolution of surgery can be traced from inappropriate open surgery (i...
May 17, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28578507/breast-cancer-electron-intraoperative-radiotherapy-assessment-of-preoperative-selection-factors-from-a-retrospective-analysis-of-758-patients-and-review-of-literature
#19
REVIEW
S Takanen, A Gambirasio, G Gritti, M Källi, S Andreoli, M Fortunato, L Feltre, F R Filippone, E Iannacone, L Maffioletti, R Muni, F Piccoli, E M P Mauri, A Paludetti, M Giovanelli, L Burgoa, C Valerii, F Palamara, M Ferro, P Fenaroli, C A Tondini, L F Cazzaniga
PURPOSE: To report our experience with full-dose 21 Gy IORT in early breast cancer patients after breast-conserving surgery to define most important selection factors. METHODS: Seven hundred and fifty eight patients, subjected to conserving surgery and IORT, were retrospectively analyzed evaluating most important clinical outcomes. RESULTS: Median follow up was 5.2 years. Results from Cox analyses defined 2 groups of patients, "suitable" (age > 50 years, non lobular histology, tumour size ≤ 2 cm, pN0 or pNmic, ki67 ≤ 20%, non triple negative receptor status and G1-G2) and "unsuitable" for IORT, with a higher rate of breast related events moving from "suitable" to "unsuitable" group...
June 3, 2017: Breast Cancer Research and Treatment
https://www.readbyqxmd.com/read/28559768/intraoperative-radiotherapy-of-breast-cancer-and-its-biological-effects
#20
REVIEW
Igor Piotrowski, Katarzyna Kulcenty, Mateusz Wichtowski, Dawid Murawa, Wiktoria Suchorska
Conservative breast cancer surgery followed by radiation therapy is the standard treatment for this type of cancer. Numerous studies demonstrate that 90% of local recurrences after traditional surgery occur in the same quadrant as the primary cancer. The published data suggest that the wound healing process after surgery alters the area surrounding the original tumor and the modified microenvironment is more favorable for the tumor to recur. The majority of metastases within scar initiated much research, and the consequences of these studies led to clinical trials aimed at assessing whether localized radiotherapy, such as intraoperative radiotherapy (IORT), would be more effective in inhibiting formation of local recurrence than the standard postoperative whole breast radiotherapy...
May 2017: Breast Care
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