Abstract
Experience thus far has demonstrated that variable combinations of external beam irradiation (EBRT), intraoperative irradiation (IORT) with electrons (IOERT) or high dose rate brachytherapy (HDR-IORT) and surgical resection are feasible and practical in settings where close interdisciplinary cooperation exists, and that these aggressive approaches appear to impact local control with and without survival. With primary colorectal cancers that are unresectable for cure or for locally recurrent colorectal cancers, both local control and long-term survival appear to be improved with the aggressive combinations including IORT when compared with results achieved with conventional treatments. These findings are consistent from various institutions and countries (MGH, Mayo, Pamplona, Japan; see Chapters 14–16). When residual disease exists after resection of gastric cancers, IOERT with or without external radiation has achieved encouraging survival results (Chapter 11). Excellent local control and long-term survival have been achieved with abdominal and pelvic soft tissue sarcomas with IORT-containing treatment approaches for both primary and recurrent lesions (Chapters 18 and 19). In the randomized National Cancer Institute trial, improved local control was achieved with lower small-bowel morbidity with IOERT plus EBRT versus EBRT alone in patients with marginally resected primary retroperitoneal sarcomas. Mayo Clinic investigators have reported excellent results for locally recurrent as well as locally advanced primary abdominal and pelvic sarcomas. Long-term salvage of approximately 30% has also been achieved with IORT-containing treatment approaches for locally recurrent gynecologic and renal malignancies (Chapters 22 and 23, respectively). With locally unresectable pancreatic cancer, an apparent improvement in local control has been noted with IOERT plus EBRT, but survival has not been altered because of a high incidence of abdominal failure, both liver and peritoneal (Chapter 12). In the treatment of pediatric malignancies with IOERT or HDR–IORT, single-institution reports reveal excellent local control and survival (Chapter 26). In lung cancer management, IOERT has reported promising local control rates when integrated in the multidisciplinary treatment of Pancoast tumors (boosting a tumor bed chest wall region after preoperative chemoradiation plus resection), or in parenchymal lesions with or without mediastinal involvement (Chapter 24). Extremity soft tissue sarcomas are technically simple to treat with IORT (either IOERT or HDRIORT) with attractive results in terms of cosmesis, function, and limb preservation rates (Chapter 20). IORT in the context of multimodal treatment for bladder cancer has proven to be able to sterilize transitional cell carcinoma and should be evaluated more extensively as an addition to chemo-EBRT for bladder preservation (Chapter 23). IORT is also being evaluated in other sites, including bone sarcomas, marginally resected or locally recurrent head and neck cancers, and selected CNS and breast cancers (Chapters 21, 25, 27, and 28, respectively).
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