Use Of IORT Research Articles

Intraoperative Radiation Therapy (IORT) for Ductal Carcinoma In Situ (DCIS): A Single Institution Study

Purpose/Objective(s): The majority of local recurrences for DCIS after breast conservation therapy occur within the lumpectomy cavity. Thus, giving radiation to the tumor bed only may be adequate for selected patients. Published data from the TARGIT trial have shown that IORT is effective in treating select early stage invasive breast cancer with shortterm follow up. We reviewed our single institution experience with the use of IORT after lumpectomy for patients with DCIS of the breast. Materials/Methods: Between 2006 and 2011, 23 patients with pure DCIS of the breast were treated with lumpectomy and IORT to 5 Gy at 1.0 cm from applicator surface. The size of the DCIS ranged from 0.2 cm to 3.6 cm. The range in age at diagnosis was 45-79 years old. Eleven patients (49%) had high-grade tumors and eight (35%) had comedonecrosis. Margins were negative in all patients and ranged from 0.28 cm to >1.0 cm. Hormone receptor status was known for all patients with 17 (74%) having ER+ disease. Actuarial local control was calculated using the KaplanMeier method. Results: The median follow-up was 18.3 months. The 3-year actuarial local control rate was 93.3%. One recurrence was noted 12 months after IORT in close proximity to tumor bed. This patients was 49 years old at diagnosis and had a 1.2 cm DCIS, grade 3, with solid and cribriform pattern, ER/PR+, and a 0.5 cm closest superior margin. She did not receive endocrine therapy. Conclusion: For selected patients with DCIS, IORT is a feasible treatment option and may be considered as an alternative to conventional whole breast radiation and/or other forms of partial breast radiation. Longer follow-up is needed to prove that this treatment technique offers equal efficacy when compared to the gold standard of whole breast radiation. Author Disclosure: A. Rashtian: None. Y.R. Zhang: None. H.R. Macdonald: None. S.F. Sener: None. M.P. Korah: None. S.Y. Zhou: None. D.R. Holmes: None.

Fatores preditivos para um bom resultado estético em cirurgias conservadoras por câncer de mama

INTRODUÇÃO: O câncer de mama é uma doença frequente e a cirurgia segmentar associada à radioterapia é considerada o tratamento de escolha para a maioria das pacientes. O objetivo da cirurgia conservadora é a obtenção de resultado estético satisfatório. O tratamento irradiante é imperativo e a radioterapia intraoperatória é uma promissora técnica de irradiação. O objetivo deste estudo foi avaliar o resultado estético final de pacientes com câncer de mama em estádio inicial submetidas a cirurgia conservadora, fechamento primário da ferida operatória e radioterapia adjuvante (radioterapia convencional ou radiação intraoperatória em dose única no leito tumoral), bem como analisar a influência de outras variáveis no resultado cosmético. MÉTODO: Fechamento primário da ferida operatória após tratamento conservador do câncer de mama foi realizado em 66 pacientes. As pacientes foram avaliadas e fotografadas e seus dados foram coletados dos prontuários médicos. RESULTADOS: Observou-se que 40,4% das pacientes apresentaram algum grau de assimetria; contudo, frequentemente a mama operada se apresentava esteticamente melhor que a mama sadia, em especial em mamas grandes (P = 0,052) e ressecções dos quadrantes superiores, que melhoravam o grau de ptose e ficavam, consequentemente, mais bonitas. (P = 0,002 e P = 0,001, respectivamente). A incisão periareolar (P = 0,008) é fator preditivo de bom resultado estético; em contrapartida, o diabetes e a quimioterapia predizem mau resultado (P = 0,046 e P = 0,073, respectivamente). CONCLUSÕES: Quando não é possível remodelar o tecido mamário, a assimetria é frequente. Incisões periareolares, mamas volumosas e tumor em quadrante superior são considerados fatores preditivos de bom resultado estético, e como valor preditivo negativo, diabetes melito, quimioterapia e tumor em quadrante inferior. A radiação intraoperatória em dose única no leito tumoral proporciona tratamento irradiante mais rápido e menos desgastante para a paciente e demonstrou equivalência no aspecto estético sobre a cicatriz e a mama.

Intraoperative radiation therapy for advanced cervical metastasis: a single institution experience

BackgroundThe purpose of this study is to review our experience with the use of IORT for patients with advanced cervical metastasis.MethodsBetween August 1982 and July 2007, 231 patients underwent neck dissections as part of initial therapy or as salvage treatment for advanced cervical node metastases resulting from head and neck malignancies. IORT was administered as a single fraction to a dose of 15 Gy or 20 Gy in most pts. The majority was treated with 5 MeV electrons (112 pts, 50.5%).Results1, 3, and 5 years overall survival (OS) after surgery + IORT was 58%, 34%, and 26%, respectively. Recurrence-free survival (RFS) at 1, 3, and 5 years was 66%, 55%, and 49%, respectively. Disease recurrence was documented in 83 (42.8%) pts. The majority of recurrences were regional (38 pts), as compared to local recurrence in 20 pts and distant failures in 25 pts. There were no perioperative fatalities.ConclusionsIORT results in effective local disease control at acceptable levels of toxicity. Our results support the initiation of a phase III trial comparing outcomes for patients with cervical metastasis treated with or without IORT.

79 poster workshop IORT in breast cancer as boost: preliminary results of a pilot randomized study on use of IORT for stage I° and II° breast cancer

79 poster workshop IORT in breast cancer as boost: preliminary results of a pilot randomized study on use of IORT for stage I° and II° breast cancer

High-dose-rate intraoperative brachytherapy for recurrent colorectal cancer

Purpose: Management of locally recurrent colorectal adenocarcinoma represents a significant challenge. Many of these tumors adhere to or invade into vital pelvic structures rendering surgery or external beam radiotherapy (EBRT) as palliative treatment. Therefore, a treatment approach was developed to evaluate the role of high-dose-rate intraoperative brachytherapy (HDR-IORT) and surgery as a component of therapy in the management of locally recurrent colorectal cancer. This is an update of our preliminary report with longer follow-up and larger patient numbers. Methods and Materials: Between January 1992 and September 1998, 74 patients with locally recurrent rectal cancer were treated with surgery and HDR-IORT. Additional EBRT was given to 29 patients, and 33 patients received 5-fluorouracil based chemotherapy. All patients underwent complete gross resection, and 21 of 74 had positive microscopic margin. The dose of HDR-IORT ranged from 10 to18 Gy. Results: With a median follow-up of 22 months, the 5-year local control, distant metastasis disease-free, disease-free, and overall survival rates were 39%, 39%, 23%, and 23%, respectively. The only predictor of improved local control was a negative margin of resection with a 5-year local control rate of 43%, compared to 26% in those with positive margin ( p = 0.02). For overall survival, a negative microscopic margin ( p = 0.04) and the use of IORT + EBRT ( p = 0.04) were significant predictors of improved survival. The incidence of peripheral neuropathy was 16%. Conclusion: The results with HDR-IORT in this group of patients are encouraging. Further improvements in local and distant control are still needed.

Mortality and morbidity with intraoperative radiotherapy for head and neck cancer

Objective: To critically evaluate the morbidity and mortality associated with intraoperative radiation therapy (TORT). IORT allows the delivery of large single-doses of radiation to a visible tumor bed with exclusion (or shielding) of critical normal structures from the treatment field. Morbidity and mortality associated with TORT has been directly studied in abdominal malignancies, but only briefly mentioned in the head and neck literature. Patients and Methods: At the Arthur G. James Cancer Hospital, The Ohio State University Medical Center, 53 patients with advanced head and neck cancer were treated with surgical resection and IORT. Twenty of these patients had intraoperative high-dose-rate (HDR) brachytherapy, whereas the remaining 33 received intraoperative electron beam therapy. All patients received 7.5 to 20 Gy of radiation. Those treated were reviewed evaluating perioperative mortality, major and minor complications, and length of hospital stay. All patients have been followed at least 3 months postoperatively. Results: There were no perioperative deaths. Additionally, there was no increase in the number of complications or length of hospital stay associated with the use of IORT The mean length of hospital stay was 13.0 days. The major complication rate was 16.8%. Of the major complications, 9% were medical and not related to the surgical site. The minor complication rate was 8%. Conclusion: As we strive to increase control of advanced head and neck cancer, TORT may play an exciting role for intensifying the therapy. At this institution, TORT did not add to the mortality or morbidity of an aggressive multimodality treatment schema.

The need for subspecialization: Intraoperative radiation therapy

Intraoperative radiation therapy represents a technically complex branch of radiaotion oncology which is undergoing intensive study. Further results of randomized Phase III trials must be available before IORT is established as an effective modality. The majority of residency training programs do not have IORT available and the use of IORT is not required for initial certification in radiation oncology. Results could be educated in the principal concepts and the technical details IORT and should be knowledgeable in the results of clinical trials in IORT. At the present time the leading investigators in IORT should consider offering a special research year or fellowship training in an appropriate residency training facility. If Phase III trials of IORT prove positive in a number of sites it is likely that this modality will become mainstream and then training in IORT should be required of all radiation oncology residents. Certainly there is insufficient evidence for subspecialty certification in IORT at the presetn time. However, one should not construe from this statement that special training in IORT is not required for its appropriate use. On the contrary, given the potential for morbidity and yt to be proven efficacy, special training in IORt should be undertaken in centers of excellence in IORT and patients treated with IORt should be entered in clinical trials whenever possible.