Abstract
The use of intraoperative radiation therapy (IORT) is increasing with the development of new devices for patient treatment that allow irradiation without the need to move the patient from the surgical table. At the moment, ionizing radiation in the course of IORT is supported most often by the use of mobile devices that produce electrons, kilo voltage X-rays, and electronic brachytherapy and the development of applicators suitable for delivery of radionuclides for short-term brachytherapy. The establishment of new treatment devices and protocols that can be foreseen in the future, e.g., the development of proton or heavy ion sources suitable for IORT or the establishment of new treatment protocols such as the use of IORT in combination with immune system modulators or radiosensitizing nanoparticles, could lead to a significant increase in the use of IORT in the future. This review discusses the still limited use of IORT at this point in time and hypothesizes about possible future approaches to radiotherapy.
Highlights
Reviewed by: Valdir Carlos Colussi, UH Seidman Case Medical Center, United States Michael Wayne Epperly, University of Pittsburgh, Specialty section: This article was submitted to Radiation Oncology, a section of the journal
The use of intraoperative radiation therapy (IORT) is increasing with the development of new devices for patient treatment that allow irradiation without the need to move the patient from the surgical table
The establishment of new treatment devices and protocols that can be foreseen in the future, e.g., the development of proton or heavy ion sources suitable for IORT or the establishment of new treatment protocols such as the use of IORT in combination with immune system modulators or radiosensitizing nanoparticles, could lead to a significant increase in the use of IORT in the future
Summary
Received: September 2017 Accepted: November 2017 Published: 12 December 2017. Citation: Paunesku T and Woloschak GE (2017) Future Directions of Intraoperative Radiation. Several exhaustive reviews of IORT were published in recent years demonstrating obstacles and successes of this field [5, 12, 16, 17], and the diverse group of treatment approaches and cancer types treated by IORT in the past few decades. Conclusions from those studies were positive in all cases—if used in appropriate patient groups and controlled correctly, IORT is a life saving procedure. Most recent review of IORT literature, cancer types treated by IORT include following: primary and recurrent head and neck cancers (IORT doses between 10 and 22 Gy, 2-year overall survival 20–60%), breast cancers (wide spectra of cancer types and outcomes), locally advanced colorectal cancers (IORT doses between 10 and 20 Gy, 5-year overall survival up to 75%), soft tissue sarcomas (IORT doses between 7.5 and 30 Gy, 5-year overall survival up to 7–40%), pediatric tumors (mostly neuroblastoma) (IORT doses between 7.5 and 20 Gy, 10-year overall survival up to 74%), gynecological tumors (IORT doses between 8 and 30 Gy, 5-year overall survival up to 47%), bladder and renal cancers (IORT doses between 9 and 20 Gy, 5-year overall survival up to 73%), prostate cancers (IORT doses between 10 and 30 Gy, 5-year overall survival up to 100%), gastric cancers (IORT doses between 12 and 35 Gy, 2-year overall survival up to 47%), and pancreatic cancers (IORT doses between 10 and 33 Gy, 5-year overall survival up to 35%)
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