Intraoperative Radiotherapy Research Articles

Preoperative Radiation Therapy is Not Associated with Postoperative Complications in Patients with Retroperitoneal Sarcoma.

The role of preoperative radiation therapy (RT) in the management of retroperitoneal sarcomas (RPS) remains controversial. A legitimate concern is the potential for worse outcomes after surgery for RPS with preoperative RT. The purpose of this study was to evaluate the impact of preoperative (± intraoperative) RT on postoperative complications in patients undergoing surgery for RPS. A total of 99 patients who underwent curative-intent surgery for primary RPS of any histology after preoperative RT from 2003 to 2021 were analyzed. Univariate and multivariate logistic regression analyses were performed to identify factors associated with postoperative morbidity and mortality. The median preoperative RT dose was 57.4Gy, and 17 patients received intraoperative RT to a median dose of 10Gy. The median number of organs resected was two. Postoperative complications within 30 days of surgery occurred in 47% of patients, including severe complications (Clavien-Dindo grades ≥IIIa) in 20% of patients. The 90-day mortality rate was 2%. On multivariate analysis, concomitant vascular resection was the only significant predictor of severe postoperative complications (odds ratio 8.76; p=0.0069). Despite increasing median preoperative RT doses from 50.4Gy in 2003-2012 to 63Gy (on a clinical trial) in 2013-2021, severe postoperative morbidity rates actually decreased from 26.3% to 16.1% (p=0.303). The administration of preoperative (± intraoperative) RT to patients with RPS resulted in similar postoperative complications as reported after surgery alone. Continuous advances in surgical and radiotherapeutic expertise resulted in lower complication rates over time despite increasing radiation doses.

Landscape of the Peripheral Immune Response Induced by Intraoperative Radiotherapy Combined with Surgery in Early Breast Cancer Patients.

A comprehensive analysis of the immune response triggered by intraoperative radiation therapy (IORT) remains incomplete. In this study, single-cell RNA sequencing and single-cell T cell receptor sequencing are conducted on peripheral blood mononuclear cells (PBMCs) from patient with early-stage breast cancer before and after IORT. Following IORT combined with surgery (defined as IORT+Surgery), PBMC counts remained stable, with increased proportions of T cells, mononuclear phagocytes, and plasma cells, and a reduction in neutrophil proportions. The cytotoxic score of CD8Teff_GZMK cells increased significantly post-IORT. Communication between CD8Teff_GZMK cells and other immune cells via MIF_CD74 and MIF_TNFRSF14 is decreased after IORT. cDCs showed an upregulation of the MCH II signaling pathway, while memory B cells exhibited enhanced activation of the B cell pathway. T cell clones expanded significantly after treatment. IORT+Surgery demonstrated the ability to partially suppress the anti-tumor effects of neutrophils. Flow cytometry analysis and co-culture experiments are utilized to delve deeper into the functional alterations in T cells. IORT+Surgery significantly enhanced T cell cytotoxic activity. Blockade of PD-1 of post-IORT PBMCs shows higher T-cell activity than that of pre-IORT PBMCs. This research highlights IORT's impact on immune cells, offering insights for targeting immune responses in breast cancer.

Multidisciplinary management strategies for recurrent brain metastasis after prior radiotherapy: An overview.

As cancer patients with intracranial metastatic disease experience increasingly prolonged survival, the diagnosis and management of recurrent brain metastasis pose significant challenges in clinical practice. Prior to deciding upon a management strategy, it is necessary to ascertain whether patients have recurrent/progressive disease vs adverse radiation effect, classify the recurrence as local or distant in the brain, evaluate the extent of intracranial disease (size, number and location of lesions, and brain metastasis velocity), the status of extracranial disease, and enumerate the interval from the last intracranially directed intervention to disease recurrence. A spectrum of salvage local treatment options includes surgery (resection and laser interstitial thermal therapy [LITT]) with or without adjuvant radiotherapy in the forms of external beam radiotherapy, intraoperative radiotherapy, or brachytherapy. Nonoperative salvage local treatments also range from single fraction and fractionated stereotactic radiosurgery (SRS/FSRS) to whole brain radiation therapy (WBRT). Optimal integration of systemic therapies, preferably with central nervous system (CNS) activity, may also require reinterrogation of brain metastasis tissue to identify actionable molecular alterations specific to intracranial progressive disease. Ultimately, the selection of the appropriate management approach necessitates a sophisticated understanding of patient, tumor, and prior treatment-related factors and is often multimodal; hence, interdisciplinary evaluation for such patients is indispensable.

ZnO Nanowire Cold Cathode Hemispherical X‐Ray Sources

AbstractCurved or spherical X‐ray sources are significant for use in intraoperative radiotherapy, adaptive static medical imaging, and high‐throughput industrial inspection, but they are hard to achieve using traditional thermionic cathode point electron sources. In this study, copper (Cu)‐doped zinc oxide (ZnO) nanowires grown on a brass substrate with a designed shape are proposed to achieve cold cathode hemispherical X‐ray sources. The strain‐driven solid–liquid growth model of Cu‐doped ZnO nanowires is proposed, and the oxidation temperature‐dependent and time‐dependent growth characteristics are investigated to optimize the morphologies of ZnO nanowire cold cathodes with a typical turn‐on field of 7.36 MV m−1, a maximum current of 12.54 mA (4.93 mA cm−2) and a uniform field emission image with an area of 2.54 cm2. Hemispherical X‐ray sources formed by Cu‐doped ZnO nanowire field emitters grown on spherical brass alloy and an Al thin film transmission anode target deposited on a hemispherical quartz glass are successfully fabricated, achieving an operating voltage of 39 kV, a dose rate of 240 µGyair s−1 and a projection X‐ray imaging resolution of 2.8 lp mm−1, demonstrating their promising use in a variety of applications.

Intraoperative Radiation Therapy for Recurrent Cervical and Endometrial Cancer: Predicting Morbidity and Mortality in a Contemporary Cohort.

Our objective was to describe the use of intraoperative radiation therapy (IORT) for the treatment of recurrent/persistent cervical or endometrial cancer and assess predictors of postoperative complications and 3-year mortality. In this multi-site retrospective study, data were abstracted for recurrent/persistent endometrial or cervical cancer patients who underwent IORT from June 2004 to May 2021. Complications were graded on the six-point Accordion scale. Variables associated with complications were analyzed with univariate logistic regression, while variables associated with death within 3 years were analyzed with Cox proportional hazards modeling. Survival was analyzed with the Kaplan-Meier method. Eighty patients had planned IORT for recurrent/persistent endometrial (n = 35) or cervical cancer (n = 45). The mean age of the cohort was 56.8 years (SD = 13.7), and the median disease-free interval from primary disease to recurrence was 20.0 months (IQR 10.0-63.1). The overall survival at 3 years was 48.6% (95% CI: 38.3-61.6%) with a median survival of 2.8 years. Within 30 days postoperative, 16 patients (20.1%) had grade 3-5 complications and one death (1.3%) occurred. Factors associated with grade 3+ complication included ECOG PS 2-3 (OR 18.00, p = 0.04), neoadjuvant chemotherapy and/or immunotherapy (OR 6.98, p < 0.01), and pelvic sidewall involvement (OR 8.80, p = 0.04). Factors associated with death within 3 years of surgery included ECOG PS 2-3 (HR 8.97, p < 0.01), neoadjuvant chemotherapy and/or immunotherapy (HR 2.34, p = 0.03), whether exenteration was performed (HR 2.64, p = 0.01), and positive resection margin (HR 3.37, p < 0.01). In well-selected patients, IORT is a feasible and safe option for the treatment of recurrent/persistent gynecologic malignancy with an appreciable survival benefit.

The value of a multimodal approach combining radical surgery and intraoperative radiotherapy in the recurrence treatment of gynecological malignancies - analysis of a large patient cohort in a tertiary care center

BackgroundRecurrent and locally advanced gynecological malignancies have a poor prognosis. In particularly, pelvic local recurrence after previous radiotherapy and/or positive resection margins during surgical treatment for recurrent disease result in low survival rates. Consequently, locoregional control is of utmost importance in this cohort of patients. The aim of this study was to analyze treatment outcomes and determine prognostic factors for patients treated with surgery and intraoperative radiotherapy (IORT) for recurrent and locally advanced gynecological malignancies.Methods40 patients who underwent surgical treatment and IORT between 2010 and 2022 were eligible for inclusion. The median follow-up time was 22 months. The outcomes measured were locoregional control (LRC), overall survival (OS), and survival without distant metastases (DMFS). The Cox proportional hazards model was used for univariate and multivariate analysis to assess the impact of patient variables and treatment factors on the endpoints mentioned. The following variables were analyzed: age at surgical treatment and IORT and initial diagnosis (< 65 vs. ≥65 years, each), disease-free interval (DFI) between initial diagnosis and first recurrence, DFI to surgical treatment and IORT, grading, histology, IORT dose (≤ 13 vs. >13 Gy) and technique (high dose radiotherapy (HDR) vs. IORT using electrons, (IOERT)). Survival curves were generated using the Kaplan-Meier method.ResultsThe mean IORT dose was 13.8 Gy (range 10–18 Gy). Cervical carcinoma was most frequently found in 27.5% of patients followed by endometrial carcinoma and vulvar carcinoma in 25% respectively. The final histopathologic results after surgery with IORT showed no residual tumour in 24 patients (60%), microscopic residual disease in 5 patients (12.5%), resection status could not be evaluated in three patients (7.5%) and the resection status was unknown in eight patients (20%). Subsequently, 27.5% of patients also received adjuvant radiotherapy of the local recurrence bed. However, after IORT, 65% of the women suffered a recurrence. Of these, the recurrences were localized: in-field 32.5%, out-of-field 22.5% and margin-of-field 12.5%. The 3- and 5-year OS was 69% and 55% respectively. The 3- and 5-year LRC was 56% respectively. The 3- and 5-year DMFS was 66% and 49%. Whereas the comparison between groups by IORT dose level (≤ 13 vs. >13 Gy) showed a non-significant trend in favor of the higher dose only for OS (p = 0.094), but not in LRC and DMFS (p > 0.05). OS and DMFS, but not LRC, differed significantly between the HDR-IORT and IOERT groups (p = 0.06 and p = 0.03,) in favor of the HDR-IORT technique. For HDR-IORT technique a trend towards superior OS and LRC was observed in the univariate analysis: HR 3.76, CI 95%: 0.95–14.881, p = 0.059 and HR 2.165 CI 95%: 0.916–5.114, p = 0.078ConclusionsThe survival rate for pelvic recurrence in gynecological malignancies remains poor and comparable with historical data from the last two decades. Particularly HDR-IORT, appears to provide a long-term oncological benefit in carefully selected patients.

Intraoperative radiotherapy might not serve as a standard therapy for retroperitoneal liposarcoma: insights from a population-based propensity score-matched study.

Difficulty in achieving complete resection leads to a poor prognosis for retroperitoneal soft tissue sarcoma, hence emphasizing the significance of adjuvant treatment. The benefit of preoperative radiotherapy for retroperitoneal liposarcoma was initially demonstrated by the STRASS trial. However, the impact of intraoperative radiotherapy (IORT) on retroperitoneal liposarcoma remains unexplored. Patients with retroperitoneal liposarcoma were identified in the Surveillance, Epidemiology, and End Results (SEER) database, treated between 2000 and 2019. Subsequently, a 1:1 propensity score-matched (PSM) analysis was conducted based on variables identified from a multivariate analysis. T-tests were used to assess differences in normally distributed continuous variables, while the rank-sum test was applied to variables that did not follow a normal distribution. The chi-squared test was utilized to evaluate differences in categorical variables. Ultimately, survival analysis was performed using SPSS to evaluate patient prognosis. A total of 2129 patients with retroperitoneal liposarcoma were included in our study. Age, sex, histology, grading, chemotherapy, and tumor size as independent prognostic risk factors for these patients through multivariate Cox regression analysis. Subsequently, 66 patients were included in the survival analysis through PSM, with 33 patients receiving IORT. Finally, the survival analysis revealed that there was no difference in overall survival among patients with retroperitoneal liposarcoma, regardless of whether they received IORT or not (p= 0.711). As an exploratory study, our findings suggest that patients may not derive benefit from intraoperative radiotherapy. These observations are intended to lay the groundwork for future prospective clinical studies.

MSOR6 Presentation Time: 5:25 PM: Intraoperative or Postoperative Stereotactic Radiotherapy for Brain Metastases: Time to Systemic Treatment Onset and Other Patient-Relevant Outcomes

MSOR6 Presentation Time: 5:25 PM: Intraoperative or Postoperative Stereotactic Radiotherapy for Brain Metastases: Time to Systemic Treatment Onset and Other Patient-Relevant Outcomes

MSOR5 Presentation Time: 5:20 PM: 5-aminoleuvonic Acid (5-ALA) Use with Concurrent Intraoperative Radiotherapy: Interim Analysis of the INTRAGO II Trial for Glioblastoma

MSOR5 Presentation Time: 5:20 PM: 5-aminoleuvonic Acid (5-ALA) Use with Concurrent Intraoperative Radiotherapy: Interim Analysis of the INTRAGO II Trial for Glioblastoma

Comparative long-term oncological outcomes of intraoperative radiotherapy vs. whole-breast irradiation in early breast cancer: a single institute study.

Intraoperative radiation therapy (IORT) and whole breast irradiation (WBI) are both effective adjuvant radiotherapy methods for ductal carcinoma in situ (DCIS) or early-stage breast cancer (BC) patients undergoing breast-conserving surgery (BCS). We aim to evaluate the long-term oncological efficacy and refine patient selection criteria based on our findings. Female patients who underwent either IORT or WBI from January 2016 to December 2019, with a minimum follow-up of 12 months were collected. IORT was administered as a single fraction of 20 Gray (Gy) to the lumpectomy cavity using the Axxent electronic brachytherapy system, while WBI consisted of a standard fractionation of 50 Gy in 25 fractions, along with a reduced boost of 10 Gy. The clinicopathologic characteristics and oncological outcomes were retrospectively analyzed. A total of 247 patients were enrolled, comprising 164 with BC and 83 with DCIS. Among them, 112 underwent IORT, and 135 received WBI after BCS. The median age was 62.2 years, with median tumor sizes of 1.5cm for BC and 1.2cm for DCIS. At a median follow-up of 64.6 months, IORT demonstrated 11 locoregional recurrences (LRR), 1 metastasis, and 1 death, compared to 4 LRR, 5 metastases, and 2 deaths in the WBI group. WBI yielded significantly higher locoregional control (97.0% vs. 90.2%, p = 0.033), although metastasis-free (96.3% vs. 99.1%, p = 0.166) and overall survival rates (98.4% vs. 99%, p = 0.688) did not differ. The LRR rate was significantly higher in the IORT group among the DCIS or BC patients (p = 0.043). The hazard ratio for locoregional recurrence significantly increased in estrogen-receptor-negative (ER-) patients in both univariate analysis (HR = 4.98, 95% CI = 1.76-14.09, p = 0.002) and multivariate analysis (HR = 40.88, 95% CI = 1.29-1297.84, p = 0.035). Additionally, IORT was associated with increased LRR in the multivariate analysis (HR = 4.71, 95% CI = 1.16-19.06, p = 0.030). At a long-term follow-up, the LRR rate was higher in the BCS followed by IORT, without significant differences in metastasis-free or overall survival rates. Our data confirmed the importance of exclusion ER- patients for IORT.

Efficacy comparison of robot-assisted versus freehand fluoroscopy-assisted minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar spinal diseases

Objective: To compare the clinical and radiographic outcomes between robot-assisted minimally invasive transforaminal lumbar interbody fusion (RA MIS-TLIF) and fluoroscopy-assisted MIS-TLIF (FA MIS-TLIF) in patients with degenerative lumbar spinal diseases. Methods: The clinical data of 114 patients with lumbar degenerative diseases who underwent MIS-TLIF in Qilu Hospital of Shandong University from January 2019 to March 2022 were analyzed retrospectively. Fifty-eight patients underwent RA MIS-TLIF (robot group) and 56 patients received FA MIS-TLIF (freehand group). There were 16 males and 42 females in the robot group, with a mean age of (56.7±8.1) years. And there were 19 males and 37 females in the freehand group, with a mean age of (57.2±8.6) years. The clinical outcome parameters were the visual analog scale (VAS) of pain, Oswestry Disability Index (ODI) score, operative time, number of intraoperative fluoroscopies, blood loss, postoperative hospital stay and complications. The radiographic change measures were the accuracy of screw placement, facet joint violation (FJV), fusion status, and change in disc height at the proximal adjacent segment. All the patients were followed-up for 2-5 years. Results: There was no significant differences in the VAS and ODI scores, blood loss, or postoperative hospital stay between the two groups (all P>0.05). The operative time was longer in robot group than freehand group [(158.5±12.1) min vs (146.4±15.4) min, P<0.001]. There was no significant difference in the number of intraoperative fluoroscopies for patients between robot group and freehand group (P>0.05). The number of intraoperative fluoroscopies for the surgeon was significantly lower in robot group than freehand group (13.8±3.9 vs 74.7±6.8, P<0.001). The rate of a perfect screw position (grade A) was higher in robot group than freehand group [87.5%(203/232) vs 70.1%(157/224), P<0.001]. However, there was no significant difference in the proportion of clinically acceptable screws (grades A and B) between the two groups [98.3%(228/232) vs 96.9%(217/224), P=0.330]. The FJV grade was significantly higher in freehand group than robot group (0.43±0.68 vs 0.13±0.43, P<0.001). During at 2-year postoperative follow-up, there was no significant difference in the fusion status between the two groups (P>0.05); however, the decrease in disc height at the proximal adjacent segment was significantly less in robot group than freehand group [(0.63±0.38) mm vs (0.92±0.35) mm, P=0.001]. In the robotic group, a pedicle screw penetrated the outer wall of the vertebral pedicle in one patient, which was adjusted during surgery. In the freehand group, two screws were inserted too deeply and penetrated the anterior cortex, resulting in mild abdominal discomfort postoperatively, which resolved by the third day after surgery. Conclusions: Robot-assisted percutaneous pedicle screw placement is a safer and more accurate alternative to conventional freehand fluoroscopy-assisted pedicle screw insertion in MIS-TLIF. Compared with freehand MIS-TLIF, robot-assisted MIS-TLIF increases the operation time, but the accuracy of screw placement is higher, and the intraoperative radiation dose and the degree of adjacent segment degeneration are reduced.

Overall survival and prognostic factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy combined with intraoperative radiation therapy in patients with advanced abdominopelvic malignancies: A single center retrospective analysis of 159 patients.

The aim of this study was to look at the overall survival (OS), progression-free survival (PFS), and prognostic factors associated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) combined with intraoperative radiation therapy (IORT). This study is a single center retrospective study performed on 159 patients who underwent treatment with CRS and HIPEC combined with IORT for abdominopelvic malignancies. OS and PFS were used to evaluate the efficacy of this treatment strategy amongst patients with abdominopelvic malignancies. The cohort's median age was 53 years, with a male predominance (58.5%). The median OS was not reached, but the mean OS was 76.87 months. In univariate analysis, several factors, including synchronous organ metastasis, Pathologic Peritoneal Carcinomatosis Index(pPCI)≥10, increased estimated blood loss, and severe postoperative complications, were associated with worse OS. However, multivariate analysis identified pPCI ≥ 10 as the sole independent predictor of worse OS. The 1-and 3-year survival rates were 83% and 70.4%, respectively. pPCI ≥ 10 and severe postoperative complications were significant predictors of worse survival outcomes. Radical surgery alone is not enough, and CRS combined with HIPEC and IORT, when indicated, was proven to be safe and effective with no added morbidity or mortality.

Real world clinical outcomes from targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy for breast cancer: data from a large cohort at a national cancer institute.

Randomised evidence supports the use of partial breast irradiation (PBI) with targeted intraoperative radiotherapy (TARGIT-IORT) for early stage breast cancer, but prospective data from real-world adoption of this technique is also important. The aim of this study was to determine if the outcome reported in TARGIT-A trial could be replicated in large cohort of early stage breast cancer treated with TARGIT-IORT. This prospective observational study analysed all patients treated with TARGIT-IORT between 2004 and 2021 in a single national cancer institute. TARGIT-IORT during lumpectomy was performed according to the risk-adapted TARGIT-A protocol using the Intrabeam® device. We analysed the completeness of follow up, 5-year in-breast-tumour-recurrence (IBTR), long term local recurrence free survival, distant disease-free survival, overall survival and breast-cancer-related survival, using the Kaplan-Meier method. A covariate analysis was performed to investigate risk factors for IBTR. We also analysed high grade toxicity events. The study included 814 patients and the a median follow up was 72 months. The majority of patients (60.3%) received TARGIT-IORT as PBI modality ("exclusive IORT" group); 39.7% received additional EBRT. There was no significant difference between the 5 years IBTR for the whole study population and the "exclusive IORT" cohort (1.6% (95%CI=1.1-2.1%) and 2.5% (95%CI=1.7%-3.3%) respectively). 5 years overall survival and tumour related survival were >95%. In 21% of patients with recurrence, breast was preserved. Radiotherapy toxicity (CTCAE Grade>2) was very rare (0.9%). This large single institute study found that breast cancer control and survival outcomes with TARGIT-IORT were consistent with TARGIT-A trial results. This "real world" experience confirmed that the randomised evidence showing the value of TARGIT-IORT as partial breast irradiation modality that can be replicated in routine clinical practice.

Outcome of Short Segment Fixation for Degenerative Scoliosis in Osteoporotic Patients Using Augmented Pedicle Screws; Prospective Case Series Study

Abstract Background When a patient’s general condition is taken into account, long-segment fusion may not necessarily be the best approach for degenerative scoliosis management. Often, a patient’s symptoms may be alleviated by short segment decompression and fusion surgery that is limited to the upper and lower vertebral boundaries of the scoliotic region. In osteoporotic patients studies reported good functional outcomes and very low revision rates with polymethylmethacrylate augmented screws. Aim of the Work This study aims to evaluate the clinical and radiological outcomes of short segment fixation for degenerative scoliosis in osteoporotic patients using augmented screws. Patients and Methods This is a prospective Case series study carried out at Ain Shams University hospitals which included 23 patients resistant back pain and lower limb claudication pain not relieved by medical treatment or physical therapy for at least 6 months. All cases managed with Posterior decompression and short segment fixation using pedicle screws augmented with cement (PMMA). Results As regards the VAS for leg pain, it showed improvement from 7.18 (± 0.07) to 1.91 (± 0.14). The VAS for back pain also improved from preoperatively 8.17 (± 0.11) to postoperatively 2.52 (± 0.24). As regards the ODI score, there was a significant decrease in the ODI scores from pre-surgery 68.09 (± 1.13) to 12 months post-surgery 25.57 (± 2.02). The Cobb angle decreased dramatically from pre-operative 15.9 (± 0.57) to post- operative, and then increased slightly but remained stable at 6 and 12 months with mean value at last follow up 4.85 (± 0.45). We did not have nonunion cases but only 3 delayed union cases at 6 months and was full united at 12 months that assessed by continuity of osseous bridging between transverse processes in plain X rays and CT scan. compared to similar published literatures This study technique has average blood loss, operation time and hospital stay and decrease the need for revision surgery but with increased hazards of high intraoperative radiation exposure. Conclusion Short segment fixation using augmented screws showed a very good clinical outcome in management of degenerative scoliosis with osteoporosis as regards VAS for back pain, VAS for leg pain and ODI score. According to radiological parameters it showed a good result in cobb angle correction, fusion rate, screws and construct stability after 1 year follow up, less pedicle screw loosening and less rate of revision surgery.

A systematic review on the techniques, long-term outcomes, and complications of partial breast irradiation after breast-conserving surgery for early-stage breast cancer.

To evaluate the efficacy and safety of four techniques of partial breast irradiation (PBI) including interstitial brachytherapy (ISBT), balloon-based brachytherapy (BBT), Intraoperative radiotherapy (IORT) and three-dimensional conformal radiotherapy (3DCRT) in the treatment for early-stage breast cancer patients after breast-conserving surgery. A systematic search was performed according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) guidelines using the PubMed, Embase, Cochrane Library and Web of Science databases. The inclusion criteria were clinical trials and observational studies that reported on outcome measures of principal PBI techniques. The methodological quality of the included research data was assessed using bias risk assessment tool with the Methodological Index for Non-Randomized Studies (MINORS), and the research information were analyzed using data analysis software. Clinical studies were collected from the earliest available date until September 2023. Fifty-one studies were included, with a total sample size of 7708. The results of network meta-analysis (NMA) showed that ISBT can lower the local recurrence (SUCRA: 73.8%). In terms of reducing distant metastasis, 3DCRT may be the best choice (SUCRA: 52.5%). And IORT has the highest 5-year overall survival (SUCRA: 90%). Furthermore, ISBT also has the advantages of lowest risk with fat necrosis (SUCRA: 72.5%), infection (SUCRA: 78.3%) and breast pain (SUCRA: 86.2%). BBT may be the optimal solution for fibrosis (SUCRA: 76.9%) and hyperpigmentation (SUCRA: 66.7%). 3DCRT has lower incidence of telangiectasia (SUCRA: 56.7%) and better cosmetic result (SUCRA: 85%). Postoperative PBI treatment using ISBT after breast-conserving surgery in patients with early-stage breast cancer may be a more valuable choice based on the treatment efficacy and is associated with fewer late side-effects. Large-scale, prospective, long-term studies are warranted to clarify the role of different PBI techniques in selected patients.

Non-irradiated area of intraoperative radiotherapy with electron technique: outcomes and pattern of failure in early-stage breast cancer from a single-center, registry study

IntroductionIntraoperative radiotherapy (IORT) with electrons has revealed to have higher rates of ipsilateral breast tumor recurrence (IBTR) than external beam radiotherapy in updated large-scale, randomized controlled trials in 2021. This study details the oncological outcomes of IORT with electron beams using our strict IORT policies. We have found new and important observations regarding the location of recurrence.Methods and materialsThis is a single institution registry of early-stage breast cancer patients who underwent lumpectomy and electron beam IORT with appropriate cone size. All patients met our pre-excision requirements. The primary endpoint was 5-year IBTR rate, with secondary endpoints being 5-year locoregional failure rate, 5-year distant metastasis rate, 5-year overall survival and, importantly, the failure patterns.ResultsBetween January 2011 and December 2022, 124 patients were recruited. The median follow-up was 6.7 years. The 5-year IBTR rate was 1.87% (95% CI 0.47–7.29%), which is much lower than the ELIOT trial and comparable with other accelerated partial breast irradiation (APBI) techniques. The 5-year locoregional failure rate was 3.68% (95% CI 1.40–9.52%), and the 5-year distant metastasis rate was 0.88% (95% CI 0.13–6.12%), while the 5-year overall survival rate was 97.52% (95% CI 92.44–99.19%). Six patients experienced IBTR. All recurrences were in surgical area, occurring superficial to the tumor bed and within 1 cm of the skin dermis. This failure pattern is very unique and might be explained by our hypothesis of the non-irradiated area beneath the skin.ConclusionsIORT with electron beams with strict patient selection criteria and strict large cone size is still an acceptable treatment for select patients with early-stage breast cancer. However, our new findings support extreme caution in the non-irradiated area beneath the skin around the tumor cavity. Given the constraints of our sample size, these findings should be interpreted cautiously and warrant further investigation in larger, more comprehensive studies.

Cancer radiotherapy with mini neutron/gamma-ray generators

Recent advancements in negative hydrogen (H-) or negative deuterium (D-) ion source technology as well as the commercial availability of high-frequency AC high-voltage power supplies have enabled the development of mini neutron/gamma-ray generators using low-energy nuclear reactions. These generators can provide a useful flux of high-energy neutrons or gamma photons in either pulsed or continuous operations. With the new mini generator, intraoperative radiotherapy as well as treatment of tumors in the brain, skin, breast, salivary gland, pancreas, liver, and kidney can be performed using external or internal neutron/gamma-ray beams. The new radiotherapy system is very compact and requires very low power for operation, enabling its location inside an operation room of a hospital or clinical facility.

Commissioning, dosimetric characterisation and machine performance assessment of the AQURE mobile accelerator for intraoperative radiotherapy

Commissioning, dosimetric characterisation and machine performance assessment of the AQURE mobile accelerator for intraoperative radiotherapy

119: Intraoperative radiotherapy and immunotherapy as combinatory adjuvant treatment of brain metastases

119: Intraoperative radiotherapy and immunotherapy as combinatory adjuvant treatment of brain metastases

1778: Intraoperative radiotherapy for soft tissue sarcoma: Experience from a Latin American cancer center

1778: Intraoperative radiotherapy for soft tissue sarcoma: Experience from a Latin American cancer center